I’m an occupational therapist. Specifically, I do research and am a Home Health therapist. This means that three days a week, I travel all over St. Louis and walk into the home of someone else and “do therapy.”

Home Health OT is one of those professions in which you come into very intimate contact with other people. I see people’s homes, filthy or sparkling. I arrive to find my clients in their button up shirt and tie, or in nothing but diapers.

I have earned my “Home Health Wings,” which means I have had bodily fluids on my clothing. Once, a client had a seizure while I was working with him. During said seizure, his bladder opened up and poured urine on my legs and feet. I have learned the value of having a change of clothing in my car.

Sometimes, I am the only person that my client sees all week. I am the only “visitor.” We maintain professional relationships, but often I am the only one who will lend an ear.

People confide in me their fears, their sadness, their joy, their confusion, their strengths. They ask questions that are hard to answer.

The other day, an older woman said, with tears in her eyes, “My sister is not doing so good. My brothers yell at her to get up and open her eyes but she doesn’t. They are putting her on hospic. What’s a hospic?”

“Hospice?” I asked.

“Yeah… what is that?”

So I had to tell her that her sister was dying.

I just started a new internship here in St. Louis, and one of my duties is to familiarize myself with a book called Yes, You Can: A Guide to Self-Care for Persons with Spinal Cord Injuries. It is produced by the Paralyzed Veterans of America, a federal organization. In it, there is a chapter on alternative medicine, which states, among other things:

The FDA does not approve or regulate any natural supplement, for several reasons. Herbal and botanical preparations contain multiple ingredients. The quantity, quality, and strength of these ingredients are often unknown and can vary from plant to plant. These compounds are not patentable, so the herbal manufacturer could never make enough money to afford to seek research trials and approval from the FDA.

This sentence seems to indicate that alternative medicine might work, but since the supplements are not patentable, people do not seek research trials of the medicine – the problem is lack of research. This is untrue. A simple search of Pubmed will generate thousands of published research papers on alternative supplements. The government itself spent billions of dollar testing sCAMs (supplements, complementary and alternative medicine). If a sCAM were proven in research to be effective, the cost of FDA approval is not prohibitive. While one cannot patent a plant, one can trademark the name associated with good research, or plant blend proven to be effective, et cetra. Most “supplements” are produced by large pharmaceutical corporations anyway, so appropriate research proving their particular product works would be a huge boon to business. This is a poor argument, and I was surprised to find it in an otherwise science-based text. Here is something else I found:

There is limited evidence, based on scientific research, that some categories of alternative medicine are effective. Several studies have indicated that therapeutic touch, massage, and acupuncture have improved both acute and chronic medical conditions. Several natural supplements have shown promising improvements in particular diseases and their symptoms.

In properly conducted research, there is no evidence that therapeutic touch works. There is clear evidence that therapeutic touch practitioners cannot detect the presence or absence of “energy fields” – it’s hard to manipulate something that does not appear to exist. Massage has therapeutic benefits, mostly for increasing circulation, relaxation, and increasing tissue mobility. Studies have shown repeatedly that one can get the same effects without puncturing the skin and without using particular acupuncture points – in other words, poking someone with a toothpick anywhere on their body has the same therapeutic effect as sticking needles in particular spots. Performing an invasive procedure on people (needle insertion) is not without risk. Putting someone at risk when one can accomplish the same results without putting them at risk is unethical. Acupuncture is therefore unethical. I can, however, recommend sham acupuncture to anyone – it’s a great placebo with no risk at all.

Speaking of alternative medicine, the other day someone told me that the reason I don’t believe in homeopathy is because I am an atheist – homeopathy requires belief in the soul, and so therefore I will use “atheist arguments” to discredit homeopathy. I just thought I would mention that being an atheist means you don’t believe in god. The existence of a soul is a separate question. One can be an atheist without believing in souls. One can also believe in souls without believing in homeopathy, and one can probably believe in homeopathy without believing in souls. I don’t believe in homeopathy because there is no evidence that it is effective and the mechanism is implausible in that it contradicts physics.

Really though, the chapter this book offered on alternative medicine was science-based aside from these two paragraphs. It described how chiropractic is not recommended for people with spinal cord injuries and gave tables of side effects or contraindications of using sCAMS. It was written in 2000, so perhaps it claims that there is evidence for sCAMS because it is outdated.

Flimsy and I don’t drink (it makes me antisocial and it makes him cry. It’s not that we don’t drink at all, rather he will sip alcoholic drinks to see what they taste like and I might have one drink every few months or so, if that.) but the other day I was thinking about how there are so many secularists in the US these days (15% of the population!) and AA (alcoholics anonymous) just doesn’t work for everyone.

For those of you who don’t know or have never been to an AA meeting, they employ a 12-steps to recovery program. The steps are as follows:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His Will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Obviously I – and many others – take issue with steps 2, 3, 5, 6, 7, and 11.

I interned at a locked mental health inpatient unit at Harvard (Beth Israel Hospital, to be precise) and while I was there, tons of people had problems with alcohol dependency. When we asked them if they had tried or considered AA, most of them told us that they had a problem with the references to god, or the idea of surrendering to a higher power. It didn’t sit right with them.

I was always willing to pass along the information about secular programs I knew of that used behavioral therapy and scientific research, rather than an obviously theistic approach. Instead of teaching people that they are powerless, these programs teach people self-reliance. My favorite one is Smart Recovery, which is very specific about it’s non-spiritual approach:

SMART Recovery® has a scientific foundation, not a spiritual one. SMART Recovery® teaches increasing self-reliance, rather than powerlessness. SMART Recovery® views addictive behavior as a maladaptive habit, rather than as a disease. SMART Recovery® meetings are discussion meetings in which individuals talk with one another, rather than to one another. SMART Recovery® encourages attendance for months to years, but probably not a lifetime. There are no sponsors in SMART Recovery®. SMART Recovery® discourages use of labels such as “alcoholic” or “addict”.

 They are also more than honest:

From a scientific perspective, the effectiveness of all support groups for addictive behavior is unproven. The only way to answer that question is to attend meetings from all available groups, and reach a personal conclusion about the best approach to recovery.

There are literally hundreds of scientific references that might be used to provide a foundation for the SMART Recovery® Program. A good place to begin reviewing them is with the works listed in “Is SMART Recovery® as Effective as AA?”, in the July, 1996 newsletter (Vol 2, #3). In particular Hester & Miller, 1995 (Handbook of Alcoholism Treatment Approaches: Effective Alternatives, Boston: Allyn & Bacon) provides a good current overview.

 Smart Recovery isn’t nearly as prolific as AA, so you might not be able to find groups in every community, which is unfortunate. There are other secular and non-religious substance abuse treatment groups out there such as Lifering Secular Recovery, Rational Recovery, and even Women for Sobriety. So, if you know someone who wants to overcome substance abuse who is an atheist, agnostic, secular humanist, or non-religious, let them know that there are alternatives.

For those of you just joining us, nearly every week, Flimsy and I go to a church. We’ve been to about 17 churches so far, and have blogged about each one of them. We usually blog about our general opinions of the church structure and members and have something to say about the sermon. This week, our friend The Alien joined us. She blogged about her experience at the church too, so go check it out if you get time.

We went to Holy Cross Deaf Lutheran Church. This church, as you might guess, is for people who are Deaf. I feel like I need to point out that Deaf culture is alive and vibrant, and does not automatically include people who are deaf or exclude people who are hearing. It is an individual’s sense of belonging to the Deaf community that makes them part of it, hearing or not. I know very little ASL, and the Alien knows more, but since I am an occupational therapy student and work in a lab located within an independent living center, I am around people who are Deaf fairly often.

At this church, the pastor is hearing and speaks English, while translating his words into American Sign Language (ASL), or having someone else translate into ASL. When members of the congregation spoke or signed, it was re-signed or translated. Some people introduced themselves by signing to us, and we were able to communicate with each other fairly well.

Since sound is not a particularly important aspect of this church, there were moments of silence that seemed a little awkward to me, such as when the choir was first preparing for song. The choir songs consisted of a recorded hymn, and instead of singing the hymn, the choir members and pastor signed the hymn in unison, while the members of the congregation signed back.  During times when the pastor spoke and a response was expected, most people signed a response.

The sermon was honestly rather plain and somewhat simplified. The speaker asked members of the congregation to tell him some of their favorite Bible verses, and told everyone that sometimes we don’t know what to do when it is time to make decisions in our lives, but that was okay and Jesus loved you. The Bible verses in turn were translated into a simpler English, which may have seemed a little odd, but there is good reason for it – If you’re Deaf, it’s much harder to learn a phonetic language than if you are hearing.

Bible verses translated into ASL take much longer to translate than to just speak them, so one can imagine that if a typical church has one interpreter for people who communicate via ASL, it is very hard to translate, and much text will get left out. The service moved slow for us, but was probably at the perfect pace for them.

Here’s a little surprise for everyone; the church records their entire service every week and broadcasts it over the internet. If you want to see the entire service, go to their website and click “church” just to the left of “Feb 22″ under “2009 Archive”.

Near the end of the service, the pastor informed the congregation that there were two groups of visitors -  The Alien, Flimsy and myself were one group, and a family with mother, father and son were the other group. The pastor had the family stand up, and they signed their names and where they were from. then, the pastor had us stand up, and we told them that we didn’t know much ASL, but that we went to different churches every week. While this occurred, the cameras were pointed right at us. If you’d like to do some stalking, this is a prime opportunity to see us caught in the act of faith infiltration.

*Flimsy
As Ziztur said, the service was very simplified.  Really only two things caught my attention.  One was the closing prayer, during which the Pastor prayed that God would open President Obama’s eyes to the fact that life begins at conception.  It’s not unexpected to hear that abortion is important enough to the church to mention in prayer even when it’s not mentioned in the service at all, but it would have been nice to hear some kind of reasoning behind this conclusion.  Without making this a huge post about abortion, I’ll just briefly say that I’ve never heard a pro-choice argument that insisted that a fertilized embryo was not alive.

The second thing that caught my attention was the children’s dedication (this was toward the very end of the service, in case anyone out there wants to see it in the video we mentioned).  This consisted of the children in the congregation moving up to the front and the pastor telling them individually, one-on-one about Jesus.  Honestly, this creeped me out.  The pastor would grasp each child gently by their chin or hair, perform a cross motion on their face, and speak directly into their faces about Jesus.  Some of these children were no more than a year or two old.  Ah, indoctrination.

The only other interesting aspect of the service was a rampaging, piss-steaming ball of energy that looked alot like a red-headed little toddler.  He seemed a bit like a crazed howler monkey on speed and viagra.  A man who seemed to be the boy’s father failed quite thoroughly, never attempted to reign him in as he bounced all over in the pews, talking and laughing loudly.  A woman (girl?) who looked like she was fifteen (if that) acted like the boy’s mother, though despite her actual efforts to get the boy to be quiet, failed as well.  Eventually, the pastor took the boy aside during a song and talked to him.  Unfortunately, the kid quieted down a bit after that.  He had been quite amusing.

Today I started my independent study at an O&P (Othotics and Prosthetics) practitioner. These are the guys that make prosthetic legs and feet for people, but they also do custom braces, carbon fiber AFO’s, braces for people with spinal cord injuries so they can walk, custom footwear, etc.

I would say O&P is the coolest kind of healthcare field one can get into – it is sort of a combination of Occupational Therapy, Physical Therapy, sculpting, and machining or auto mechanics (but with less grease). The practitioners are the same guys who build the prosthetics, so they’re a lot more gruff and a lot less politically correct – machine shop language is allowed.

I like this. The front office is decorated with posters of really extreme dudes skydiving with prosthetic limbs, old guys pushing grandkids on bikes, people playing tennis with artificual arms. The back is kind of like a machine shop filled with replacement body parts ad dudes wearing scrubs and holding drills. this is my kind of place.

So the other day I was in my research lab and a client who is about 12 years old came in. Previously she had been in the lab and her wheelchair was adjusted all wrong – she had outgrown it the way it was set up, but since it was a pediatric chair and capable of being adjusted as the kid grew, it was easy for me to adjust so that it better met her needs. After doing so she left happy, mostly because she could reach her wheels better now that I had adjusted it.

The client comes in being pushed by her sister, and I notice right away that one of the legrests on the chair is sort of swinging around like it isn’t locked into place. It’s making it hard for her to get through the door and looks pretty uncomfortable.

We (the physical therapist in the lab) and I ask why her legrest is all wacky, and the girl tells us it’s always like that. Of course, it wasn’t like that last time, or I would have fixed it.

I don’t know about anyone else, but if I am wheeling around in a wheelchair as my main mode of mobility, it would drive me crazy if it were even slightly maladjusted. My passion as an occupational therapist is proficient use of manual wheelchairs, and so I have my own and it’s always perfectly adjusted.

I take a look, and the wheelchair is missing this peg that the footrest locks onto. So I wheel it over to the warehouse full of wheelchair parts adjacent to the lab and rustle around in a parts bin, find a replacement peg, and screw it on. I show sister which part was missing, and she says, “Oh! I found that laying in my car the other day and didn’t know what it was… so I threw it away.”

I also notice that the back is on incorrectly, so that instead of being straight up and down, it leans forward. There are two ways to put the back on, and sister has put it on incorrectly – which is an easy mistake really, but you’d think one would notice if the backrest on a chair was tilted forward.. I ask sister if she has noticed this and she has no idea that there is more than one setting on the back. I take some green tape and stick it on the wheelchair as a visual reminder of the correct setting.

The best part was that the client was super happy that I fixed her chair for her. This is exactly whay I decided to be an OT.