Thread by @_Eric_Reinhart

I often take care of people after suicide attempts. When they explain why they tried to die, a large proportion say they could no longer see “the point” in life. “There’s no meaning for me, no reason to live.” Most clinicians push against this idea to dissuade people from it. 1/

Many are fearful of acknowledging truth in our patients’ words. I often find it useful to, rather than oppose this personal nihilism, instead lean into it. It’s more honest. Many who have made many attempts and seen countless psychiatrists immediately see through canned lines. 2/

Yes, there is no intrinsic meaning or purpose in your life. This is difficult; it’s also the reason there’s possibility for you. The task of living is to invent meaning and purpose, and then invent it again. It’s work. Much of the time it’s painful. Sometimes, it’s also joy. 3/

But this work of living is especially challenging in a society that doesn’t support people in the task of meaning-making and offers so few sites for cultivation of purpose with others—and many of those that exist are destructive.

It’s why I want us to build systems for this. 4/

It’s systems that offer meaningful, rewarding, and organized opportunities to both give & receive care that we most need to rebuild community, health, and safety in America. Rather than doubling down on failed police and prisons models, we need an entirely different paradigm. 5/

And it’s not just patients who need these systems to help generate a satisfying sense of meaning & purpose. We as doctors, therapists, social workers, nurses, & caregivers need this. Working in our failing US healthcare system is intensely demoralizing. We need more, together. 6/

Much of what’s called “burnout” in healthcare has less to do with poor working conditions—no worse than they were 20 years ago—than growing disillusionment. It’s increasingly hard to believe that our work is part of the solution rather than perpetuating our for-profit problem. 7/

It’s by building genuine community care systems via the practice of accompaniment in which the giving and receiving of care are intertwined that we can make Lilla Watson’s famous statement below mean something in both material and spiritual terms. 8/
bostonreview.net/articles/eric-…

This thread could just as easily have begun with the lives of people with whom I work who’ve committed acts of violence. Erosion of social fabric along with material deprivation due to neoliberal US policy has led to isolation and nihilism. Like community, safety demands care. 9/

“accompaniment is not simply good for public health [it’s also about] community-building, an ethically oriented politics of care, & the abolition of inherited structures of oppression that often subtly reproduce themselves in our efforts to undo them.” 10/
bostonreview.net/articles/eric-…

If you’ve read this far, figure I might as well try to get you to read my attempts to imagine ways forward. Hence the above essay and the below, which addresses the plague of public distrust from which we’re suffering and what it’ll take to end it. 11/
slate.com/news-and-polit…

And @gregggonsalves and @akapczynski’s essay, also linked in one of the subthreads above, lays out what I believe is an essential public system. My add would be that we should be even bolder: not 200,000 but an initial goal of 2 million workers. 12/
bostonreview.net/articles/gregg…

2 million community health+safety workers in America might sound unrealistically ambitious. But consider that it would be still only half the number employed by the law enforcement industry and less than half the number of nurses we have in the US. It’s a very realistic goal. 13/

To all those who’ve sent messages, I’ve read each one and wish I could engage in the way you deserve. Unfortunately, I cannot. This underlines why what we need is armies of accompagneuteurs working in community to provide care & simply be alongside those who are hurting most. 14/

Not why I posted this, but it happens I have an ideal opportunity to build a program to implement this accompaniment paradigm in US communities. I need, however, to raise funds to enable it. If you may be able to support this, please reach out for more info about the project. 15/

Be warned it's also about using community health+safety worker systems to end mass incarceration and reliance on policing rather than care. So if decarceration, shared safety, & reparative justice aren't among your priorities, might not be a good fit. 16/
undark.org/2022/01/06/the…

Relatedly, as addiction arises in relation to the same policy factors mentioned above that foreclose a sense of life possibility for millions of people, please read & then share with your representatives our new harm-reduction explainer in @thenation. 17/
thenation.com/article/societ…

accompagnateurs* (ie, those who accompany)