You can go home again

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WellCare founder Ed Ullmann.

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Clutching one of those composition books that were ubiquitous when I was a kid, Ed Ullmann came to my house in Mount Tremper on a recent Friday afternoon. Ed has been a neighbor a long time. Despite a peripatetic lifestyle that has taken Ed to many distant locales, he and his wife of 35 years, Patty, a nurse, have kept their house on Miller Road, about a mile away from where I live, for the 40 years I’ve known him. He’s living there full-time again now.

Ed is best known as the founder of WellCare, one of the first health maintenance organizations in the country. WellCare morphed out of a small group of Ulster County people Ed organized called the Mid-Hudson Health Plan. The first name on the first page of the composition book Ed wanted to show me was mine. The date on the entry was October 9, 1981. The other names on that page were those of Chuck Lawson (president of Rotron), Art Weintraub (then with Mid-Hudson Pattern for Progress, I think), and Assemblyman Maurice Hinchey. It took several years of meetings before Ed’s unflagging efforts brought WellCare to a successful birth.

I was glad to see Ed. He hasn’t changed much over the years. You’d probably be happy to have half the ebullience and optimism Ed exudes. I would. The enthusiasm with which he’s been blessed is contagious.

An idealistic young pharmacist, Ed had once been a political wunderkind, elected to the Ulster County Legislature at the age of 24 (in an upset, he bested Shandaken Town Supervisor Ray Dunn by one vote). He later served as the county’s mental health director when Tom Roach was legislature chairman.

The birth of WellCare

WellCare, Ed’s baby, grew quickly after its establishment. Ed proved a principled and visionary leader, a prophet before his time. The emphasis in HMOs should be not on fees for services, but on prevention, awareness and wellness, Ed felt. Back in the 1980s, Ed was arguing that affordable health care needed to be extended beyond the traditional insured population to the entire public. He sought to integrate Medicare patients into the WellCare culture and emphasized primary care.

His thinking was expansive in other ways. To add to the community’s cultural base, Ed partnered with art and theater groups to present programming at WellCare’s posh corporate headquarters on Hurley Avenue. Ed was feted with national “Entrepreneur of the Year” awards. The enthusiastic young man from Mount Tremper was riding high. At its peak, WellCare had 120,000 members.

WellCare came under competitive pressure from more traditional insurance plans. Massive consolidation in the industry had lowered premium income at the same time the costs of re-insurance had soared for WellCare. Ed came to believe that his company had to grow even faster to survive. So the firm went public, converting from non-profit and getting a listing on Nasdaq. With $30 million in fresh capital, WellCare hired additional managers, updated its computer systems, and prepared for a busy future. It was an expansive time.

The rosy future was not to be. In 1996 the business magazine Barron’s criticized the company’s financial records. It maintained that WellCare had greatly inflated its profits picture. A big kerfuffle followed. The financial statements for 1994 and 1995 had eventually to be revised. The stock plummeted. Ed maintained that short sellers had undermined the company in order to make a big profit for themselves.

Lawsuits followed. Ed was eventually forced out.

What did Ed learn? “The more you move off the local and the personal, you lose buy-in,” he told me. “Going public, with all its financial and organizational advantages, was a big mistake.” Community institutions must avoid abandoning their roots and becoming institutionalized.

Think again

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Collage illustration by Will Dendis

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Suicide. The word is a complete sentence, a complete thought, a complete statement. I know from personal experience. When I was a child, I sometimes experienced intense impulses late at night or during stressful periods to run a knife deep into my arm from my fingertips up to my armpit. For me, the impulse was as powerful and real as yearning for an umbrella in the pouring rain.

What is that about?

My goddaughter suffered a similar impulse, and ultimately took her life in her early twenties by hanging herself with her dog’s leash a few nights before Halloween. Hers seemed a sudden, probably unpremeditated decision. Her body was found feet away from matching sets of Halloween costumes for her and her baby sister. Her mother blames a psychotropic medication used to treat anxiety that many attribute to exacerbating suicidal impulses.

When I was assigned this article, I put out a blast to my near 1000 social-networking “friends,” calling for their stories, assuring anonymity. More than ten responded with extremely moving stories, leaving me feellng honored, amazed, humbled and even slightly changed for having heard them. The telling of personal stories is inextricably complicit in healing. For me, my first-paragraph admission had been my small effort to illuminate the vast black cave through which so many have passed alone in the dark. Not everyone surfaces.

Suicide prevention counselors select their words carefully, especially with the media, even to the point of circulating information pamphlets on “Safe Reporting on Suicide”. They are willing to go deep, but not too deep, into the dark world of the phenomenon.

The replies I received included those from two deeply respected friends who had come forward almost immediately with stories from their backgrounds which I had known nothing about. Both Shelley and Anabelle (not their real names) expressed to me the hope that their “survival stories” might inspire others to survive their own ordeals.

My acquaintance Shelley is a mom of two who owns a thriving business. She said she found herself in the midst of a disintegrating marriage in the mid-1980s with a man who made her feel worthless. She became convinced that her kids would be better off without her. About to become homeless and jobless, in her mind she felt useless to society, convinced that she was unlovable and undesirable. At this very rock-bottom point of vulnerability, she was attacked and raped.

“Someone entered the apartment I had just moved into and brutally beat me,” she said. “The attack was compounded by the way I was treated by the police, all friends of my ex-husband, who was also a cop. I am a fairly practical person. Even in the plan to end my life I had planned everything so it would be the least inconvenience for those around me. It all made such perfect sense at the time.”

Shelley described herself as so emotionally overwrought that she went numb, apathetic. “I just didn’t care about anything because whatever I did was wrong, and obviously I was a bad person being punished on some cosmic level for being the type of person that I was,” she said.

Shelley, who was pregnant at the time, cooked up a suicide plan which she described as very sensible, even likening it to a grocery list. “It was with a great sense of clarity and resolve that I had decided that ending my life would be not simply the best solution,” she said, “but the only solution acceptable.”

Shelley managed to pull back from the brink of suicide. She met her now-husband while pregnant with that baby. He supported her completely, even accompanying her during the C-section she had 40 weeks after the attack.

The psychology of love

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You’re in love … and it’s a beautiful thing. You’ve never felt so alive, so excited, so hopeful about the future. You feel so lucky: you’ve found the yin to your yang, the sugar to your tea, the jelly to your peanut butter.

Do you ever wonder what made you choose each other?

According to attachment theory, the answer lies in your early childhood. It’s a hot topic, thanks to a best-selling book with the cumbersome title Attached: The New Science of Adult Attachment and How It Can Help You Find and Keep Love. Authors Amir Levine and Rachel Heller apply the theories developed by British psychologist and psychoanalyst John Bowlby, which are a mainstay in early childhood psychology, to our adult relationships.

Attachment theory found that our behavior in relationships is formed by our perception of safety and security with our parents. Researchers put a child and a parent in a room full of toys. At one point, the parent was asked to leave the room for a short time. The researchers watched the child’s reaction. Even more importantly, they saw three very different reactions when the parent returned.

Some children grew anxious when they realized they were alone, but quickly calmed down upon the parent’s return. Those children had an attachment style the researchers called “secure.”

Another group cried inconsolably, even when the parent returned. Their play time was ruined. Their entire focus became the need to cling to a parent who’d disappeared. They were labeled as “insecurely” attached. Their style was called “anxious.”

A final group seemed entirely unconcerned. In fact, those children pushed their parents away when they returned. This, the researchers concluded, was an avoidant attachment style.

Let’s get beyond what seems like a rather mean exercise, and talk about what this might mean for you, young lover.

According to adult attachment theory, there’s a very good chance that your adult relationship style hasn’t changed much since you were a little tyke. Neither has your beloved’s. The key to making your relationship work is to understand what each of you needs.

First, attachment theory says we have a genetic need to be in a close relationship — maybe more than one. So you’ve got that going for you.

The next step, if you don’t already know it, is to figure out your relationship styles. How? There are a couple of options.

You can pay attention. Do you tend to be insecure? Do you worry a lot? Are you constantly wondering what people think of you? After an argument, do you question your entire relationship?

If you do, you just might be anxious.

Does your beloved behave like a steady ship through any storm? Is she or he calm and reasonable, able to weather relationship and life crises without thinking the world is falling apart? She sounds secure.

Real addiction

 
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Photo by Dion Ogust

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The most abused and most deadly addictive drugs in America don’t come in glassine envelope or a bit of tinfoil discretely passed hand to hand in a bar. Instead, they come in neatly labeled prescription bottles handed off over the counter at your local pharmacy.

Abuse of prescription drugs, especially opiate painkillers like hydrocodone and oxycodone is increasing in New York State and nationwide. According to the federal Office of National Drug Control Policy, prescription narcotics are the second most commonly abused drug in America, behind only marijuana and far ahead of cocaine and heroin.

In 2008 an estimated 15,000 Americans died from prescription-drug overdoses. Between 1998 and 2008 the number of patients seeking substance-abuse treatment for prescription drug abuse increased by 400 percent. The rise in abuse tracks closely a rise in the overall number of prescriptions for narcotic painkiller written legitimately and legally by doctors.

According to a report by New York attorney general Eric Schneiderman, between 2007 and 2010 the number of prescriptions for hydrocodone written by New York doctors rose by 16.7 percent. During the same period prescriptions of the even more powerful opioid oxycodone rose by an astounding 82 percent.

“It keeps going up while everything else is holding steady or going down,” said Cheryl DePaolo director of the Ulster Prevention Council, which coordinates county drug prevention efforts. “And we’re seeing these drugs abused by every age group.”

Dr. Alexander Weingarten is a certified pain treatments specialist and president of the New York Pain Society, a professional organization of medical practitioners in a variety of specialties which deal with patients in chronic pain. Weingarten traced the expansion of painkiller use, for both legitimate and illicit purposes, to a 1989 declaration by the World Health Organization that freedom from pain was a basic human right. The declaration led to new standards for practitioners, new requirements for insurance companies to cover painkillers and new incentives for drug companies to market them. Perhaps most importantly, Weingarten said, patients came to expect that their aches and pains would be treated promptly and effectively.

“Before that, doctors were fearful about prescribing opioids,” said Weingarten. “Before 1989 pain was undertreated, and people just walked around in pain.”

Keep the dream alive

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Logan Michael.

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Jim, Crystal and Logan Michael plan to attend the kickoff party for the local Walk to Cure Diabetes at Diamond Mills in Saugerties next Thursday, August 16. The event, a benefit for the Juvenile Diabetes Research Foundation (JDRF), will celebrate the fundraising accomplishments of 2011 and welcome teams for the upcoming 2012 walk at Cantine Field on the morning of Sunday, September 23. Walker check-ins and entertainment begin at 9:30, and the actual walk is scheduled to start at 11 a.m.

Since its founding in 1970, JDRF has funded $1.6 billion in research to cure, treat and prevent juvenile diabetes, the more serious of the two types of diabetes. JDRF-funded research has led to promising leads to fight the ravaging disease. “We want to keep the dream alive,” says Jim Michael.

Type 1 diabetes (T1D) is a disease you never outgrow,” explains the website for the Albany-based chapter of JDRF. “Adults with Type 1 diabetes not only have to face the everyday challenges of managing their disease at work and home, they also have to deal with lack of awareness from the general public. It’s just as important for adults with T1D to know they are not alone as it is for kids and teens.”

You can help by supporting JDRF. Go to www.jdrf.org.

The Michael family, who live in New Paltz, have first-hand experience with the juvenile-onset form of the disease. Let Jim Michael. Logan’s father, explain his introduction to it in his own words:

“On Monday, August 17, 2009, my wife Crystal and I took our son, Logan, for his routine physical to our family doctor. Everything seemed to be fine; Logan was a happy, healthy, seven-year-old boy. We received a call from our doctor on Friday that there was sugar in Logan’s urine. We were assured not to worry, that this could be caused by many things. He suggested we bring Logan to a pediatric endocrinologist to follow up.