Articles

2019 South Dakota Farm and Ranch Stress Summit: Dr. Mike Rosmann Keynote Presentation

October 9, 2019


[music] Thank you very kindly Whew,
This was gripping and thank you so much Amber for being so brave that you would share your
personal story. This is the topic that we have to deal with,
and while its very hard to follow such a powerful experience that Amber was surly not planning
on, but its something that we have to face. We’re in our fifth year, where the income
from farming and ranching is equal to or exceeded by the expenses and we are seeing an increase
in people ending their lives. How terribly difficult it is for us to understand
what Amber and her family has gone through. Even more difficult is what Chris went through. We have to start somewhere, and I commend
you, the Extension and thank Andrea for making this summit possible, so that we begin to
face the questions that are so troubling and for which we don’t have good enough answers. Yes, we know more, and that is my task here
to try to share the research, underpinning of what is known, but there is more that is
not known. But its clear from Amber’s experience and
her loss that there are more questions than there are good answers. Yes, we do have some federal buy in finally
with the farm and ranch stress assistance network, I will be talking more about that
tomorrow. But I hope to mostly do here today is to present
what we do know, as well as many of the unanswered questions. I would like to take your questions as we
go along rather than have you wait till the end because its more important that we answer
your questions than it is those which I surmise that we need to answer. Every circumstance, every place is different,
everyone of you in here is different. Every person that ends his or her life has
a different set of circumstances, and we can’t judge. Its important that we not use the word commit
suicide, it is not an act of commission it is an act of surrender, from what we know. We cannot judge what is in the minds of persons
who have fought a brave battle and couldn’t come up with adequate answers to keep going. But we have to tackle this very painful subject,
just like we have to understand better the stresses that effect Agricultural producers
everywhere. I just came here from Farm Aid in eastern
Wisconsin, the concert was wonderful, but even more wonderful was the interaction of
the attendees, mostly farmers and ranchers. It was the most activist group that I’ve seen
since the farm crisis of the 1980’s. My role was with the American Psychological
Association, which partnered with Farm Aid for the first time to sponsor the concert
and activities. And I think that said something, it could
be any other organization. It could be Extension, it could be professional
behavioral health counselors, social workers. We are in this together, to figure out better
solutions to the unknown questions, the unanswered questions. The discussion in the meetings before the
concert were very very meaning full as people told their stories to make farming more profitable
but most importantly more rewarding physiologically and financially. It was a comfort to see so many people there,
36,000. It was absolutely wonderful to listen to the
musicians and to get to know some of them a little but. Yes, Willy came on, it was midnight before
he started, it was 2:30 before we got to bed and we had to leave eastern Wisconsin and
drive yesterday through four hundred and fifty miles of rain before we got to dry weather
in western Minnesota and the Dakotas! It was clear! That experience, in many ways gave me courage
to move forward with this kind of conference where we have more questions than answers
but w have to start somewhere. We will learn about the farm and ranch assistance
network, it is derived from research and support programs that were on going from 1999 to 2014,
and still are in someways ongoing. So the farm and ranch assistance network is
not the end all answer, its just a step in the right direction. And it is 10 million dollars for each of five
years, not billion I wish it were billion, we need that kind of commitment to get the
answers and the supports that are needed. I thank Andrea for the that wonderful introduction,
I might say that my life in this arena began before the farm crisis in the 1980’s. Marilyn, my wife and I were professors at
the University of Virginia, in Charlottesville. I had grown up on a farm in western Iowa,
Marilyn in grew up in Idaho, of Japanese American farmer ancestry. We had always wanted to raise our children
on a farm, so after fiver years at the University of Virginia we left to move to a farm in Western
Iowa near family, so our children could attend the excellent schools that we have in the
midwest. Little did we know that the farm crisis was
to begin two years after we left Charlottesville, we arrived just in time to begin, to try to
provide assistance to troubled people, and to try to figure out some answers. So I’ve been at this for 40 years and we’ve
made a little bit of progress but not enough. Please do take those articles that were sent
and have been duplicated for you. Or Andrea, if not duplicated, are they online? Somebody knows (Andrea off camera – They all
have copies), OK, Yes, Great, Wonderful If you have need to contact me, feel free
to email me first, I am so busy right now that I have to request that you email me first
and then we can try and set up a time to talk if that becomes necessary. We will look at today why farming is so terribly
stressful, what we know about the stresses, what don’t we know, how does the behavioral
health of farm and ranch residents, farm workers, migrant workers does our behavioral health
differ from the general population. Are these differences due to the fact that
we are working the land and taking care of water and air and using these vital resources
to produce essentials for life. How does that perhaps set us up to be different
from the rest of the population. Why do we farm? Given the difficult finances and the troubling
stresses – so we will look at that. We’ll mostly look at the underlying reasons
for stress and why we are having this conference today, and concentrate more tomorrow on solutions
and you’ll find many answers in the breakout sessions as well. Let’s begin with behavioral well being and
why is it important for healthy food production. Notice that I’d used the behavior instead
of mental, and I do that for good reason, the term has become the acceptable term at
the federal level since April of 2006. It was rural people who moved the dial when
we met to formulate a rural mental health Strategic plan in Jackson Hole, Wyoming in
May 2005. It was then called the Rural Mental Health
Summit. Several of us said the word mental doesn’t
fit well. We say about people derogatorily, Oh you’re
mental. But behavior is a term that is more acceptable,
especially to farm and ranch people who understand the behavior cattle, horses, swine, sheep. The more we know about their behavior the
more we can utilize that knowledge their growth rate and productivity in dairies. There are learnings from animals that apply
to us humans as well. So when we use the word behavior it does not
stigmatize, it is not mysterious, it is something that we have control over unlike so many of
the other factors that Amber so clearly described and which Governor Rounds and Brad Rasmussen
also mentioned. So behavior also looks at a range of solution
givers or helpers. It includes anybody who impacts our behavior,
which means that lenders must have some knowledge about behavioral well being now. We are seeing behavior integrated into curricula
in ways that we never could have imagined. The science of behavior, psychology is only
a 100 years or so old, unlike chemistry and physics, which are two to three centuries
older, we are behind, but we can measure how frequently we cry or pray or laugh. How intensely the tears flow, and whether they
are tears of happiness and joy or sorrow and loss. We can control our behaviors more than we
can control the weather, government policy and other factors that impinge on our lives. So if possible don’t use the word commit and
use the word behavior as much as possible. We are seeing whole departments change their
names from psychiatry to the Department of Behavioral Health. It includes the whole person, our mind, body
and spirit. It includes a range of solutions from those
offered by professionals in the behavioral health field, social work, behavioral health
therapy, psychology, advanced nurse practice, pastoral counseling, but it also includes substance
misuse counseling. The work of extension personnel to help people
figure out how to manage our finances, our behaviors more productively. It includes the efforts of agronomists and
the time is coming when we will see behavior integrated into genetic knowledge, in the
new field called behavioral genetics or behavioral bioinformatics. My son in law has his phd in behavioral bioinformatics,
and has devised a number of the test that look at the human genome to figure out the
site on the human genome where depression originates and anxiety disorders and so forth. So we are making small steps, but even though
we have a ways to go. What are some of the contributors stress? Well they are up here in print but they vary
for every person and situation. Those stressors that effect agricultural producers
the most are those beyond our control. The most important stressors are those that
we can’t control and as Amber indicated, financial stress was a major factor, so was the planting
season which brought into Chris and Amber’s thinking, “Are we going to make enough this
year to, that we can service our loan or loans?” We know that financial threats are at the
top of the list of stressors for farmers. You’ll see in this first set of slides that
threatened loss of the land is the most potent stressor for the land for producers, whether
it’s ranch land or farm land, or if your are fishers or foresters, forest terrain, or boats. The USDA definition of a farmer as everybody
in extension knows and includes all producers of food and fiber. So that includes hunters and fishers and foresters,
as well as workers, migrant laborers, ranchers, farmers. What we also know is that after the threatened
loss of any of those important resources needed to farm, that is the land, but it can also
be our equipment, our livestock, our facilities, our human capital or labor, our financial
underpinnings. Any threats to those necessities to farm successfully
make us hyper alert and overreact. now we are at a point where uncertainty has
been greater than it has been for a long time because of our foreign trade relationships. We are not sure whether the renewable fuel
standard will allow small individual cooperatives that produce ethanol to remain viable. We don’t know if we’ll get back our markets
to China. Yes, dairy has finally improved a little bit
but its going to take three years of prices for milk well above the cost to produce that
milk to dig out of a long hole that has occurred for 8 of the past 9 years. We can’t control changing consumer preferences. So not only are farmers distressed but our
whole rural communities dependent on agriculture are stressed, much of what we heard at Farm
Aid, were about why don’t corporate entities that support farming do more to help. Its a good question, I don’t know the answer. Let’s look a little bit at some of the good
news about the behavioral well being of agricultural producers, when we compare our current recession,
which is the worst since the farm crisis of the 1980’s with the highest rate of suicide
since the 1980’s especially in those areas that do not have a support programs. It is also the worst rate of bankruptcy and
foreclosures since the 1980’s but there’s a lot of good news. The good news is that we have not lost nearly
as many farmers and ranchers as we did in the 1980’s. During that difficult era, 20 percent of all
agriculture producers had to cease production. There is an ongoing continual consolidation
of agriculture as everybody knows with farms getting larger, if they are conventional operators,
simultaneously, and I think this is part of the good news, we are seeing the emergence
of many small operations. Often which are regenerative or sustainable,
that is they try to put necessities back into the soil and the water that are needed to
produce food, like fertilizer in the form of manure, or fodder from plants, or cover
crops. We are seeing people shift in these productive
ways of managing land. We are seeing more and more organic farmers
emerge and who farms small parcels, ranging from an acre maybe up to maybe several hundred
acres. We visited a farm, or farmer I should say,
in Wisconsin, who manages five thousand acres of organic farm land. So we are seeing some food things, there’s
a whole generation emerging who wants to take over farming. Its not as bad and what many of us think,
that our sons and daughters don’t want to farm because its too stressful or they don’t
have the capital to get started. There are enough programs around to help farmers
begin, that sources of credit are more readily available than they were in the 1980’s. Some other good features about today are that
we have services to keep people around, mediation, farm crisis help lines and hotlines, which
I’ll say more about. Ag safety and health programs that sprung
up in the 90’s. We have reduced the death rate from physical
causes of fatality on the farm, and when I say farm I’m including ranch, we have reduced
them by half. Child deaths on the farm have decreased even
more but we have not improved the rate of caring for people with psychological stressors
or injuries, and that’s the part that we have to address. The rate has continued up. We have better understanding of behavioral
health than we ever had, I think it’s partly because of the media, which have done a superb
work. You can’t pick up a farm or ranching magazine
without it having at least one article about farm stress or behavioral health problems
on the farm or ranch and what to do about them. So the knowledge of behavioral health has
just grown by leaps and bounds. Farm people are much more open than they have
been in the past to reaching out for help. Chris and Amber certainly did that, it wasn’t
enough. That is the gnawing question, what else is
needed. But we have better resources now that what
we had, in terms of understanding that we can manage our behavior. Let me give an illustration. Research in Sweden was undertaken of dairy
operators and workers and also feedlot operators and workers. When the operators and workers rated their
mental or psychological well being as troubled, they had a much higher rate of veterinary
visits to the farm operation. The most distressed farmers had the highest
somatic cell counts in their dairy milk, more mastitis. When farm workers felt that they were included
or valued in the operation, their adaptations or adjustments improved. So the communication between the managers
and the workers was a key factor in improving their behavioral well being, not only for
the workers, employees but also for the managers. Happy managers, make happy employees and happy
cows, you don’t have to go to California to find happy cows. So it is important for us to know that when
we are tense, probably its going to effect the quality of our decision making on the
farm or ranch, and its going to impact how able we are to focus our full attention on
the farm and ranch operation. When we learn how to manage our behavioral
health, its a step in the right direction. I have found that people in my neighboring
towns cut out the farm articles and they take them during the winter months for coffee and
they talk about them over coffee. Who could have imagined that, a generation
ago? Farmers talking about their behavioral health,
wow! So they don’t have to just talk about how
many snow drifts they drove through to get there. I think it is important to know that farmers
and ranchers now hug each other. In my depression support group for farmers
and ranchers, when they see each other, they bump chests, we give each other a hug. There are tears from men and they talk openly
about what they don’t understand and why they are depressed. Who could have imagined that 25 years ago? That doesn’t mean everybody does but we got,
we’ve improved a lot. Yes? (Voice off camera – where do you hold your
farmer support group at?). We have been holding it in my office until
I close my office down, sometimes in church facilities, a room in the library, sometimes
in a room in the back of the bank, any place, even in the back room of a restaurant. It just needs to be a neutral site, and its
ok now for farmers to park their cars out front, they do! It was especially nice that I had my office
in a flower shop, because when people parked in front of the flower shop, they could have
been going in to buy roses for their spouses or whatever. Or they could have been coming down to see
me. Talking about roses, in, on February 14, Marilyn
and I were heading down to Little Rock, Arkansas where I was to speak to the Arkansas Farmer
Bureau, on our way down we decided “Let’s go a day early” and spend some time at Hot
Springs National Park. We decided to see if we could get a room at
the resort there, the old, old resort there that’s almost 100 years old. We called them and they said, ” You know for
another 150 dollars we can give you the Valentine’s Day Special, and I thought about that and
realized that Marylin and I have been married for 47 years. It was about time to celebrate it, so we said
yup, we’ll spring for it. We get to the room and here’s rose petals
put all over the bed, red roses in a vase, chocolate covered strawberries, towels folded
up like two swans that are facing each other that are shaped like a heart. Marilyn has to take pictures and send them
to our two kid, our two children. First my son responded, “Are you sure this
is dad? This isn’t the dad that I know?” (laughter)
And to add to my misery, my daughter said, “Usually you just buy her another vacuum cleaner.” (laughter)
Well they know what the real story is, they grew up on our farm. They’re both back Iowa finally. More about stressors, we know that the loss
or the threatened loss of land or assets needed to farm are at the top of the stressors list,
but not to far behind are the loss of a child in a farming event. When the child is deceased in a farming event,
we can’t get away from the scene, or when a person ends his or her life, we can’t get
away from the scene because we live on that place. It makes it hard for us, imaging how hard
it made it for the person who ended his or her life. We know also that, after the death of a child
there is loss of hope that the farm will pass onto another generation of operators. After they, the loss of a child is equal to
the loss of a farm at the top of the list. They are followed by in third place, the loss
of an important contributor to the operation, it can be a spouse, could be a father, could
be a valued employee. Fourth is the loss of a spouse in death especially
when its unexpected through something like a crash or when its even expected like cancer,
heart disease and so forth. Fifth is divorce and right close to divorce
and right next to divorce is machinery breakdown, disease out breaks and inclement weather,
6,7,8th. It is interesting that divorce is as high
as fifth, but I think it is that high because the solutions to divorce often involve separating
out the property which leads to a great deal of strife in many troubling relationships. So there is this good news about farming that
we manage our stress better, but let me talk a little bit more about the American Farm
Bureau Federation poll, done by Morning Consult in April this year. Somewhat over two thousand rural residents
of the United States were selected to represent all rural residents. Remember that rural people comprise 17 percent
of the US population. That is people who live in communities under
10,000 and on the farms and ranches or smaller villages. So the vast majority of Americans, 83% are
suburban or metro but we rural people have much importance because we are the source
of the food but also are the source of important substances that are needed for minerals, metals,
wood, and so forth. It intrigued me how native people at Farm
Aid talked about the importance of water. Water is medicine. We need to take care of our water and our
soil. They are gifts from God, they are all around
us. God is all around us, Mother Earth is with
us, Air, Water, Land. The American Farm Bureau poll showed that
30 % of farmers said poor mental health, and I said mental
because that’s what they used, is a major problem for the or their workers. As times past they might not have said that,
48% of rural residents said they are experiencing more mental health challenges that they did
a year ago. With younger persons feeling the most vulnerable. 31% of farm residences sought assistance,
while 21% of farmers and farm worked sought outside assistance. That’s an improvement from the farm crisis
era, where we had to take services to people and to find them at farm auctions or when
they were referred by court, or in some cases by spouses. During the farm crisis of the 1980’s, 65%
of the callers seeking assistance were women, it has completely reversed. Now to our hot lines and help lines, 58% of
first time callers are men, who could have imagined? It is a step in the right direction to have
your Avera Farm and Ranch stress line but you have many more than that here in South
Dakota, Catholic Family Services, Lutheran Social Services, a community support system,
pastors. We have to depend on our nurse practitioners
and physicians, but most of all we have to depend on each other. And its important that this conference is
bringing together people to be exposed to mental health first aid training. Another thing that the American Farm Bureau
poll showed was that 82% of farm residents said that their mental health is important
to them or their family. 91% of farmers or farm workers said financial
issues and fear of loosing their farm impact their mental health. Amber knows all about that. It says indeed that this list of stressors
correctly identifies the loss of the land at the top of the financial stressors or the
top of the stress list. Stigma cost and lack of access to competent
health are factors for not seeking help. The number of psychiatrists and psychologists
per hundred thousand persons in South Dakota rural areas is half that of urban areas. Where do our professionals locate in our state? In the larger metropolitan areas, near the
hospitals. We don’t have adequate resources on the farm
and ranch. The number of mental health professionals
needs to be increased in several ways by training local providers, the doctors, the nurses,
school councilors, pastors and extension. Even our valued farm people. Yes? (Voice off camera – I’d like to ask a question
about the mental health and I’m still on point number one here, 91% of farmers and farm workers
said financial issues and fear of loosing their farm impacted their mental health, now
I lived in the city for about 30 years and now I’m back home and back on the ranch, so
I kind of see the city perspective and now I’m reacquainting after being gone for so many
years, I’m learning how farmers and ranchers think and what they are facing. Now what I’m hearing is that, and this is
really could sound political but its where they are at, I mean its where they are at,
they are afraid of losing their operation, they are afraid of losing their cattle herd. And, Um, I got a letter recently, a copy of
the letter that I could share with you, you maybe have seen it too, it was from a producer
who was saying how packers are controlling the cattle market, and I’m not going to try
and explain all of it but, packers, the packing industry controls the cattle industry to the
degree that they are making as much as 450 dollars per carcass. While cattle people are going broke and foreign
beef coming in is effecting prices and trade and everything. Then there is this issue again I’m hearing
from this guys, the beef checkoff money, is controlled by the packers and so I learn about
this and so I call my representative, yes here we go, and I call my senators, and I
said I’m hearing this is a real problem. You know what can we do to change this around,
we’ve got to have country of origin labeling, seems like that’s what these guys are telling
me, we, they wish the country of labeling. Now when I called the offices, they go gosh
we really can’t do anything about that, its controlled by somebody, and kind of pass the
buck. So anyway farmers and these guys are risking
losing their operations feel like they are between a rock and a hard spot, and we are
hearing the oh we want to help you with your mental health, and we will get more money
to help you with your health but it won’t fix the root problems.) You’re right about that, it was what we heard
a great deal at Farm Aid. We know that it does take real solutions to
income to ease the stress. Policies have to be changed and I don’t want
to get to much into that because I want concentrate on behavioral well being, but I don’t want
to ignore it because it is in many ways the key, yeah. This year particularly, just to advance a little
of that, your point, we lost a million calves due to weather, some were little calves where
their mommies, their mothers had taken them down to the timber along streams so that they
could calve there, and the little calves were born and couldn’t get out of the way of the
rising water. We had more dummy calf syndrome this year
that we’ve had for a long time. We don’t know the full contributors to dummy
calf. For those who don’t know what that is, it
is when a calf looks entirely decent at birth but can’t stand up, um, it often has inability
to nurse and we try very hard to keep it going by putting a tube down into the stomach, keeping
it warm because it can’t regulate its temperature very well and we can only save about 10% of
them. We don’t know the full story of what’s causing
that. We also have the problem of too much rain
that has effected cropping. I nearly had to stop on I-80 yesterday over
by Mitchell, where the water was so high it had, was washing over the interstate but I
understood that it was worse the day before. But we have, we have to have solutions that
are meaningful, the supplemental payments haven’t done the job. Farmers and ranchers feel, they tell me that
their loyalty is being purchased, they’re farming for the government. They don’t take good stock in, we’re from
the government and we are here to help. They want to produce and to be paid fairly
for their efforts not supplemented to that they vote in a particular way. I think that I will let that go for now and
talk more about behavioral health because we all have our own opinions about this matter
and the solutions and its a topic that isn’t going to go away quickly, but one that needs
constant addressing and solutions. To bring us back to this farm bureau poll,
most people said that the num, the rural residents would like to see their providers trained
better in their culture and in their stressors and their solutions. So good counselors need to understand the
culture of agriculture producers. The word agriculture has two stems, Agri and
culture. The agri part is important to agronomists,
and to farmers. The culture is maybe even more important. So important that we understand the behaviors
of agricultural producers to the point that we integrate behavioral training into agriculture
curricula. We need to see that integrated into the training
of extension, people that are getting degrees at South Dakota State in Ag. In our community colleges in Agriculture,
even in vocational ag in high schools, and in FFA and 4-H.
I think the time is coming when we will focus as much on behavior as on physical health,
and zoonotic illnesses that can be transferred between animals and humans. Let me go now to how our bodies react to stress,
so I’m going to shift gears just a little. Many of you are familiar with stress and what
it does to you. First we appraise if a situation it threatening,
so does a cow when she’s going up the shoot. She’s look to see if there is a way out ahead
of her, is there a loud noise up a head, is there a combination of light and dark coming
through the walls of the shoot that looks unfamiliar and looks threatening. She is appraising whether she can go into
that shoot, she can do several things. She can fight the threat by baulking and refusing
to go into the shoot. She can take flight from the threat but running
so fast through that we don’t catch her in the catcher. Or she can freeze, not many cows freeze, possums
do that. We humans do that, we take flight when we
feel threatened by not talking to the lender, by withdrawing from social activities at church,
and 4-H and school. Or we fight the threat by saving I’m getting
an attorney to deal with this one or we threaten people with if you take my land away from
me I’m going to end it all and you might be one also to go. Yes I have talked to many people who have
seen individuals end their lives, in the lending office to make a point, or we, I have seen
people freeze to the point that they can’t crawl into the combine or the truck cab because
they are so emotionally paralyzed they can’t get up and go about the activities needed to
complete the days work. When we appraise the threat and feel it is
threatening, our muscles tense, our heart rate increases to push blood around to our
muscles, our blood pressure increases, our pupils dilate to take in more information,
our senses sharpen. If no further threat occurs, our nervous system
is able to resume production of healthy bodily chemicals, serotonin which gives us a sense
of well being. Serotonin norepinephrine. That is why anti-depression medications usually
combine serotonin and Norepinephrine or at least have one of those ingredients in their
formulation. These are essential body hormones that make
us feel healthy and well and able to laugh. Oxytocin is secreted when the cow lets down
her milk, when we laugh heartily, when we are relaxed. So if there are no further threats, then we
secrete cortisol. Our bodies recuperate from the stress of muscle
tension, rapid heart rate. We start to relax, say Whew that was close
I’m sure glad that is over. The cows says after she’s had her shots, or
after she’s been AI’d, whew, I’m glad that is over. That reminds of another story. I AI’d all of our cows that we AI, that was
not artificial intelligence by the way, but when I was in a hurry and I got the cow in
at 6:30 in the morning and I needed the job done of inseminating her, and I, so I could
still get time to change clothes, take a shower and get to work by a quarter to eight at least,
when I was doing my counseling. As I was trying to find the cervix with my
left arm up the cows rectum and I was uptight, she was having spasms and was trying to expel
my hand and arm. When I said Mike calm down, take your time,
just relax. As I relaxed, the cow sensed it, just like
dogs sense it when we relax, so I got the job done, the tail goes up and says Mike you
hit the spot. So I know that when I am relaxed, my cows
relax, we took care of each other. So we need these times, when cortisol prepares
us for the episode when we need to get tensed up again because there’s a threat. But when the threats come regularly like they
did for Chris, he didn’t get a chance to relax. He couldn’t sleep, we find sleep deprivation
to be a prime procreator or antecedent to ending ones life or attempting to end ones
life. So if you are thinking dreadful thoughts,
you don’t get a chance to respond with cortisol production and to relax and to finally rest
but instead you’re geared up constantly. To some extent the use of medications can
help, but we need to know what medications and when to use them. I have, or had a client who’s husband ended
his life. He called me on Thursday afternoon on the
way to see his family physician. His lender said to him, you need to get medication
because you’ve gone for two nights without resting. He took that recommendation to heart and called
his wife and said “I’m going to see our doctor”. Then he called me while in route and said,
“The lender said I need to talk to you.” and I said, “What’s going on?” He told me I can’t sleep, I said I hope you’re
on your way to the doctor’s office, he said yes. I said while we talk would you please pull
off the road, and he made some notes, he put down my telephone number. And he went to see his physician who gave
him a medication that included serotonin. Not knowing that it was planting season and
that this man was stirring the seeds in his soy bean boxes on the planter to level them
off. But he wasn’t using rubber gloves, the seed
coating was getting in through his skin into his body system. The toxic substance works like this, we have
a nervous system with two cells separated by a space called a synapse, in that space
are a number of fluids. They include acetylcholine which transfers
the message from one cell to the next cell instantaneously, so fast that an nerve signal
can go though many of these nerve cells and passage synapse from our brain to our toe
and back in the span of less than one tenth of a second. As little as one hundredth of a second in
the minds of prime athletes with very sound rapid reflexes. This particular chemical blocks the acetylcholinesterase
which breaks down the acetylcholine in the synapse acetylcholinesterase takes the cetocolin,
metabolizes it, and then, the next time the nerve cell fires the acetylcholine is released
into the synapse and the message goes from one cell to the next. Serotonin is an upper, it worsens the condition
of already being hyper alert. Insects get the toxin into their system when
bees visit sunflowers that have been sprayed with organophosphate insecticide or clover
that’s been sprayed to get rid of aphids. When the bees goes back to the hive with some
nectar and pollen, it is delirious be the time it gets to the hive. That’s both good and bad, Its good that thee
hive mates don’t know where to go for additional nectar, to find additional nectar on their
own. But its bad in that they hive doesn’t get
enough nutrition, and the bees experience bee colony collapse, which we know if somehow
corollated but we don’t full understand how it results in the death of the colony. But we do know that it has become unacceptable
to collect information on the number of bee hives in our country. Because it might show some light on what’s
happening to our bee populations, how awful. I better be careful to not go into this politics
any more. (Voice off camera – Go ahead)
Ok, Thank you. The exposure to toxins in this farmer who
was planting his soybeans was keying him up and serotonin worsened the condition. He didn’t know that, neither did the physician. The physician had not taken a course called
agricultural medicine, its a course taught in 14 medical schools around the country. It teaches physicians how to detect frequent
illnesses and injuries that farmers experience in the pulmonary system, just like Willy at
Farm Aid had, has probably COPD. He performed but was not as accurate as he
used to be, he was always taking a pause. (Breathing)
But he’s 86 and he got through his set, anyhow. The human body tires to get rid of the toxins
by frequent urination, by tear flowing, tears flowing, by mucus flow, by um, diahrrea even
vomiting. But it can’t rid of all of it because it attaches
to our fat cells, so every time we are exposed to the same toxin we are accumulating more
and building up a greater amount in our bodies and that is what was happening with this man. And the physician didn’t know that his treatment
was worsening it. It is why we need people to have proper training
to understand the culture of agricultural producers. It is why we need the farm and ranch stress
assistance network, to now set up for regional centers around the country. Each center is designed to provide technical
assistance to local resources that want to do something to address farming issues and
to make farming safer. There will be a center in the northeast, the
south, the midwest and the west. The call for proposals was due on July 27,
the awards had been made, but I don’t know the successful applicants. I know many of the unsuccessful applicants
but I have not seen a press release that indicates where these four centers will be. We need these four centers for agricultural
behavioral health. We also need the best practices that came
from our research over 15 years and from our research during the farm crisis there in the
1980’s. At any rate, what we know is that when we
are stressed we try to find relief, what are the most common behavioral problems of the
agricultural population. (Voice off camera – Can I ask you a question?) Yes. (When you talk about medication for producers,
you discussed that serotonin is not good for them right? What medication would be helpful. I know it varies per person but there is a
client that is farming right now and is prescribed a med that he is really struggling on and
it has to do with seratonin. So now we are questioning what would be a
useful one?) Yeah there is so much to say, I hope I have
enough time in our two days. It’s ok, I’m going to answer your question
because its important, what are the medications that can be used? The medications that would have helped this
gentleman were probably the anti anxiety meds in the diazepam family like valium, zanax,
other medications that curtail the build up of anxiety because that’s what happens when
we go through a threatening circumstance. first we become alarmed, that alarmed phase
keys us up to do something if we don’t calm down, we eventually deplete ourselves of well,
of serotonin and norepinephrine and oxytocin. Cows that are stressed don’t give as much
milk, nor do animals in the feedlot grow as fast when they are stressed, nor do we sleep
well. So we know that after we have become alarmed
we must manage that alarm, we have to recognize it, but did you know that farmers are prone
to overeating to stress? Those of us that have Germanic ancestry,
carry us in a predisposition that I like to call the totonic gene. Two Tons inhabited central Europe until they
were pushed into the nordic countries, into Great Britain, into Easter Europe, as barbarians
filtered into central Europe after the holy Roman, the Roman Empire, the era of the Holy
Roman Empire. So it was in the middle ages, this tendancy
to overreact makes us good farmers because we’re always on the lookout for threats. And to deal with them. But it sets us up to eventually deplete ourselves
of serotonin nor norepinephrine, oxytosin and we become tired, fatigued, and cortizol makes
us a little be fat, because we’re preparing our bodies for the next onslaught of stress. So we do need to know that anxiety almost
always precedes depression. So it was anxiety that was an uncertainty
but that was killing people and is killing farm people. But we need to know what to do about that
and we need to train people to differentially recognize depression versus a toxic reaction,
to certain farm chemicals. So that is the kind of training that comes
from agricultural medicine courses, which cover all the human body systems, pulmonary,
cardio vascular, muscular, skeletal, behavioral. I often teach the behavioral section, but
the course is taught in medical schools so that they eventually develop their own cadre
of persons who will carry on this course. There are 6 textbooks in agricultural medicine,
there is none in agricultural behavioral health. I had an hour and a half to cover behavioral
health in a 40 hour course. We need whole courses, that’s why we need
these centers and that’s why the farm and ranch stress assistance network is a valuable
step in the right direction, not a complete step but its a start. We need a whole education system that trains
providers to serve the behavioral well being of agricultural producers. What are the kinds of behavioral health issues
that we experience? The first and most common reason that people
called our hot lines, we started in 2000 or 1998, if you remember 1998 it was a time when
pork prices dropped to 8 cents a pound one afternoon in late September. Wow that is low. There was worry in Congress and the Federal
Administration at that time that was the Clinton Administration, that we could be heading into
another crisis in agriculture like we had in the 80’s. Let’s see if we can forestall it. They gave four million dollars to the Wisconsin
Office of Rural Health and the Wisconsin Primary Health Association, which brought representatives
together from 7 states, Wisconsin, Minnesota, North Dakota, South Dakota, Nebraska, Kansas,
and Iowa. It became clear that Wisconsin entities could
not continue the program because their main duties were to serve the people of Wisconsin. So the leaders from the 7 states formed a
consortium called Agri-Wellness, which became a non-profit corporation in Iowa. I was their director and am still their director. Jim Kinyon was on our board for quite a while. The work that we did was to look at why people
called help lines and hot lines, what worked to diminish stress on the farms and ranches. We found several common denominators from
our work in the 1980’s and our work in the 2000’s. Because agriwellness went from 2001 to 2015
appx. We found in the 1980’s, that the loss of the
farm was the greatest stressor, equal to the death of a child. We found that same stressor still in the 2000’s. We found that the loss of the land was the
most potent. Now I’ll have to say more about why that is
probably tomorrow. Remind me to talk about the agrarian imperative,
its another theory, remind me also to talk about the ADHD tendency that exists in farmers
and ranchers, yes there is an upside to attention deficit hyperactivity disorder, makes us
good farmers and ranchers. The behavior, reason why people called our
hotlines, first and foremost to say there’s something wrong in our relationship, he won’t
talk to me, she spends all the money when she’s in town, if she could just keep the
money in her purse, it would be a whole lot better. No son we need you at home, you can’t play
football this fall, we can’t afford a hired hand to help haul the grain we need you. Its complaints about the marriage, about relationships
and stress that are the first and foremost reason why people seek help. So relationship problems is the most common
symptom of behavioral distress in a farm family. Second was adjustment problems, for those
of you who know the diagnostic and statistical manual of mental disorders, everybody gets
the diagnosis. Those diagnosis go to the Center for Medicare
and Medicade Services, which collects every insurance form that is submitted around the
country. They tabulate these data, to keep track of
how many people have depression, how many have gall stones, how many people have diabetes
and so forth, essential information. Trouble is though that insurers have access
to the Center, or called CMMS, and they can see that depression is a precipitant to suicide. So they raise the premium for life insurance,
or before the affordable care act, they put writers on conditions like depression, the
very thing for which insurance was needed. So we have to address the whole issue of insurance
or maybe not even filing an insurance claim. So the Farm and Ranch Stress Assistance Network
does make is possible for people to receive counseling or medication management without
an insurance claim. It operates like and employee assistance plan,
and that’s the way agriwellness operated our seven states. We found that our best practices included
hotlines and helplines, counselors who were trained in agricultural behavioral health,
you had to have 27/7 availability of these hotlines and helplines and you had to provide
counseling when farmers and ranchers need it and can access it. That means weekends, evenings. We found that community workshops greatly
benefit the whole rural environment, not just farmers and ranchers. But brining together business people with
agricultural producers generates solutions to the community wide problems, because farm
income turns over as many as 6 times in our local communities before its finally expended. So we learn these things, which I will say
more about tomorrow, but I now wanted to finish what are the most common illnesses and reasons
why people called the hotlines. We looked at 48,000 or 43,852 callers from
September 2005 through October 2007. Those 43,852 people complained of relationship
problems followed by adjustment problems with too much anxiety or too much depression. Third, was anxiety disorders, so the buildup
of alarm with too many threats going at one time. We can handle two but we can’t handle three. After anxiety because of what I explained
in the general adaptation syndrome, depression follows, and that is our contributor to our
nefarious problem of suicide. What we don’t see much in the agricultural
population is substance misuse, as a primary diagnosis, surprise. But it accompanies depression or anxiety in
almost half the cases, so it is a co-occurring diagnosis in about 40 to 50 percent of distressed
farmers and ranchers who seek help. But people drink to escape thinking, people
use methamphetamines to keep operating the combine. People use opioids so they don’t feel the
pain physically and sometimes psychologically. So we do have to pay attention to substance
misuse. What we don’t see in the agricultural population
are high rates of personality disorders, they are too incapacitating. We don’t see high rates of psychotic illnesses
with delusions or hallucinations, command messages saying kill this person because he
is taking your farm away or something like that. So psychosis have been sorted out in all farm
and ranch operations except for the Hutterites, Mennonites, and Amish because these are the
communities where they take care of one and another, and they take care of the chores
when someone is disabled. Its a better farm program than our USDA. So we do see some problems with psychotic
illness in these highly religious communities. But we don’t see people in farming and ranching
with a lot of chronic behavioral health problems except the genetic predisposition to depression
and the tendency to ADHD. ADHD was first discovered in Kenya sheep herders
and cattle drovers in the country of Kenya in Africa. The work was done by Dan Isenberg of Northwestern
University at that time, he’s now at the University of Washington. He noticed that the most successful farmers
in Kenya, with the most goats, sheep and cows tended to be hyper alert. They didn’t need much sleep. They were always on the lookout for green
pastures. They were on the lookout for predators, like
lions and when they examined their genetic structure he found had that they had four
times the incidents of ADHD, of less successful sheep herders and cattle herders. We now know that ADHD runs in farmers throughout
the entire world. Where as the germanic teutonic gene occurs
mostly in Germanic people, you do find it in others of different heritage as well. Because not just Germans get depressed, you
can find even depression in happy go lucky people, in hispanic, latino people. People of color but we always see this tendency
to ADHD in the agricultural population and the tendency for depression. That then sets us up for this high rate of
suicide. How am I doing for time? Am I there? OK
So we’ll have to conclude this morning, I’m going to hang around for the entire day and
be here this evening. And all of tomorrow until we have to head
back to Iowa after lunch. So I’ll have some books out there, I’m not
trying to sell you the books, you choose if you want it, it is a book that has done quite
well but it is. But I’m selling it instead of the listed price,
you can have it for 15 dollars, and if you don’t have 15 dollars on you, I’ll take 10,
if you don’t have 10 I’ll take 5. So don’t let that money issue bother you,
I’d like you to have the book. Its a series of stories about farming and
behavioral health and fly fishing of all things. So thank you very much for your attention
and more later. (music)

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