If you consider the kinds of things that are said and done regarding cognitive problems, and swapped out the cognitive problem for another issue like race, religion, sexual orientation, or even other disabilities, it wouldn’t be as funny, or tolerable, or even make sense. This article tries to get across why I say cognitive impairments are the last refuge of bigotry in the developed world.

The other day, I saw a man who was walking unsteadily across an alley with the kind of awkwardness that comes from brain damage. The driver of a big white van was impatient and took off, roaring just inches from this man as he was getting across. That will show him for taking too long to heal his broken nerves.

Years ago, I was kicked to the curb after experiencing a brain injury, with the employer perfectly happy about the prospect that I might be too feeble-minded, at that point, to realize I had rights to medical care and other options. With a little luck, maybe I would just walk away and maybe get permanently lost.

I saw a pretty, young bank teller display anger and irritation as she dispensed with an elderly woman who had become too confused to manage her banking effectively. Maybe with a little luck, the old lady won’t have family members who know where her money is and the bank can just absorb it.

I experienced managed care companies and treatment professionals insisting that people with brain damage are now recovered, even though they can’t keep a job.

I reviewed the alarming statistics on homelessness, and how much of it is caused by cognitive disabilities trampled by society’s cruel contempt for anyone who stumbles. And suicide? We can’t be sure about the numbers, but in light of what I am sharing with you, what do you think?

And I must mention the matter of business models. There are marketing approaches and business models for every demographic. The ones for people who are experiencing cognitive problems are chilling. Consider Publisher’s Clearinghouse mailings that are designed to look like an intimidating bill. Bear in mind that they primarily target the elderly. Consider marketing of a mailing list of elderly people touting how gullible they are. And bear in mind that this was proffered by a large, respectable corporation traded on NASDAQ called InfoUSA. And bear in mind that this list was being sold to known con artists.

Somehow, it seeps into our cultural bones that people with cognitive difficulties deserve what they get, and that it’s pretty funny, too.

One of the greatest leaps a minority can make, is to rid itself of the psychological effects of bigotry. This was one of the reasons that the Supreme Court of the U.S. forced school integration. A minority of people who are deeply ashamed have internalized the stigma emanating from the myths of society. Unless they are able to get a good advocate in their corner, or have enough money to get the right attorney, the combination of shame and difficulty with problem solving can practically paralyze a person, making a person with cognitive problems feel like they are swimming with the piranhas, as various interests carve them up. For those who have a type of difficulty that they can recover from, it often takes so long, that their assets are long gone before they are able to wage an effective self defense.

In part three, I will offer up another clinical example in more detail than the ones in part one. It will show just how all of this can creep into the bones of highly qualified clinicians.