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August 28, 2016
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Siege Mentality

When resources are scarce, it is human nature to try to prioritize and cut back until the situation improves. Usually, these are either short-term or seasonal shortages, giving us some idea of how long we will need to endure -- a sort of "countdown" calendar to work against. When we don't know how long the shortages will last, when necessities such as food, water, and medicine will return, we hunker down into what is called a "siege mentality". The problem with a siege mentality is that it can lead into a downward spiral, with the shortages getting more and more pronounced, until it seems impossible that there will be an outlet or that it will arrive in time... or until the besieged die.


I first realized I'm in a siege mentality when a recruiter offered a possible contract that, had I owned a car (and all the necessary accoutrements, such as insurance and gas), would have been a reasonable commute, for a company I would want to work. Without a car, the commute would be four hours each way and cost far more money than I could scrounge up to cover the period between a potential first-day of work and a first paycheck. Trying to keep enough resources to commute an hour or more by public transit means having no money for hypertension medication, test strips, or anything other than cheapest-available food (which means "nothing appropriate for a person with either diabetes or hypertension, much less both").


I'm hardly alone. In the shrinking, debt-laden, overextended US economy, many are faced with losing the homes they've lived in for years, only to fall behind because of job layoffs, underemployment, or lowered compensation, higher medical costs (even with very good medical insurance), higher commuting costs, and the costs of supporting elderly parents and un- or under-employed adult children. While the Wall Street Journal may focus on homeowners and mortgage foreclosures, renters face the same home-insecurity issues: the landlord's loss of a property can mean the eviction of all its tenants, as may a renter's loss of income due to unemployment, lowered compensation, increased medical costs, or increased commuting costs.


There is a correlation between foreclosure rates and declining health; a recent Wall Street Journal article cites research claiming a 7.2% rise in emergency room visits and hospitalizations for hypertension and an 8.1% increase for diabetes among adults ages 20-49. Care sought for other stress-exacerbated conditions -- including anxiety and attempted suicides -- was also higher in areas with high foreclosure rates. While the authors -- of both the article and the research -- were careful to note that correlation does not imply causation, the mainstream media have been reporting for years how the poor, uninsured, and undocumented have been using hospital emergency rooms in place of "normal" medical care, seeking assistance only in emergencies, at places which are required by law to provide service regardless of the patient's legal status or his ability to pay.


Preventative healthcare and health maintenance are luxuries compared to food and shelter; it should surprise nobody that those who are uncertain about the basics of life must defer the long-term future in favor of the present. It's that same siege mentality. While common sense suggests that financial (and shelter) uncertainty would trigger or exacerbate stress-related illness, in the absence of correlated primary-care statistics, the research is but anecdotal.

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