LONELINESS

Many years ago I treated a patient who was suffering from a near fatal case of loneliness.

 

No, I am not exaggerating for this person would later confess that she had come to me in a last-ditch attempt to resolve her problems while promising herself that if I couldn’t help she would hang herself. She was a 20-something attractive and very modestly dressed woman who did indeed look very despondent with the psychomotor retardation and furrowed brow characteristics of clinical depression. When I asked her why she was there to see me, she hung her head, stared at the floor, and tearfully responded that she had been shunned.

 

She went on to tell of how her infraction of the church’s rules (one that most of us would consider a minor infraction) had resulted in her being officially designated as one with whom the entire church should have no contact whatsoever. You may be thinking: “Big deal go find another church.” But her story was more complicated. She had grown up attending this church. It was the center of not only her spiritual, but also her social and family life. Since the church doctrine insisted that only members of their church were true Christians, the members were warned about the dangers of consorting with people outside the church, apparently convinced that sin was contagious. Thus, when alienated from the congregation, which to make matters worse, included her entire family, she found herself totally alone.

 

Such stories are not new as evidenced by Nathaniel Hawthorne’s tear-jerker, THE SCARLET LETTER, but give witness to the importance of relationships and the pain of loneliness. Many religions have used banishment of varying degrees of severity to punish wayward members. The Catholic Church’s policy of excommunication appears to be less stringent and is viewed by the church as a means to save souls whereby one can return to the fold and regain salvation by repenting. Such tools are powerful and their use can have long lasting effects. For example, I recently discovered that my Great, Great, Great Grandfather was shunned and ejected from the Quaker church. It occurred to me that if he had toed the line, I might be a Quaker.

 

AND YOU THOUGHT SMOKING WAS BAD

Solitary confinement has long been used as a means to enhance the discomfort of imprisonment, and is agreed by many to be a form of torture. In a previous blog, WHAT’S LOVE GOT TO DO WITH IT? I contended that our need for relationships is encoded in our DNA, having evolved long ago as a major contributor to the survival of our species. If one were to accept that premise, it would be logical to assume that loneliness could be a major problem for us. Indeed, according to Vivek Murthy, M.D., the former Surgeon General of the U.S., loneliness has become “a growing public health crisis.” He has said that loneliness is a more effective agent in reducing longevity than obesity, and that its toxic effects are worse than smoking 15 cigarettes per day. Recent research into the prevalence and effects of loneliness tends to confirm Murthy’s assessment. Last year Cigna released a report on a study of 20,000 people age 18 and over as measured by the UCLA loneliness scale.

 

Nearly half reported loneliness as a problem, but even more concerning was that 27% felt no one understood them, and 43% admitted they felt their relationships were not meaningful. One in five felt they rarely or never felt close to others or that there was anyone they could talk to. It was also noted that Generation Z (those born after 1996) were the loneliest of all the generations measured.

There have been a number of studies which confirm the effects of loneliness on physical and mental health. It is not surprising that it could result in affective disorders such as depression, and may help explain the increase incidence of suicide as mentioned in my previous blog, but there is also evidence that loneliness can cause or aggravate innumerable maladies including: hypertension, coronary artery disease, dementia, inflammatory diseases such as arthritis, impairment of immune systems, and even some malignancies to name a few.
A study in the Archives of Internal Medicine sponsored by the National Institute of Health followed 1604 people over the age of 60 (average age 70) for 6 years and measured their physical decline and mortality rate. Their stark conclusion was: “Among participants who were older than 60 years, loneliness was a predictor of functional decline and death.” Need I say more about our need to engage with our fellow man?

 

WE ARE NOT THE ONLY LONELY

It turns out that we are not the only nation where loneliness has become a problem, both from a public health and productivity perspective. Great Britain’s parliament has recently appointed a commissioner to investigate remedies for what has been called a silent epidemic after a study showed that 20% of Brits reported they were lonely most or all of the time. It appears there are similar studies in progress in other European countries. It would be helpful to know if loneliness is a worldwide problem or peculiar to our culture.

NOTHING ELSE TO DO

If one accepts the premise that loneliness is a significant problem, the question arises as to how did we get this way and what can we do about it. Prior to the industrial revolution, multi-generational families provided a sense of belonging. Relatives galore, including parents, siblings, cousins, grandparents, aunts, and uncles usually lived in close proximity. With the switch from an agrarian to an industrial society, there had been a migration to cities where houses were built close together, which resulted in the development of neighborhoods usually composed of people with common interests. There was the inevitable clustering of children who interacted with only minimal adult supervision, and stay-at-home moms who could relate to each other in a very personal way. Neighbors were evaluated based on certain standards including friendliness and mutual respect. The lack of air conditioning and television made front porches very popular especially on hot evenings, and provided an opportunity for informal socializing. The only taboo subjects were sex, religion, and politics.

 

BETTER THINGS TO DO?

Soon after World War II ended, front porches began to disappear from neighborhoods, and there was a wild rush to the suburbs where large green lawns were treasured and families had fewer opportunities to be “neighborly.” On hot summer nights, it became more comfortable to be inside the house (with air conditioning) than outside. There were also new-found entertainment devices available – first radio, then TV, movies in the VCR and then DVD Player, video games, and then the internet which gave us social media and streaming. One could go for months or longer without ever having face-to- face contact with one’s neighbors. There was no longer danger of an errant foul tip sending a baseball through someone’s window. Privacy became important, and it was no longer considered a snub to build a fence between houses.  There were no kids playing hopscotch on the sidewalks, as a matter of fact, there often were no sidewalks in these new neighborhoods.

Competing Schedules and Activities

As more mothers joined the workforce and children were exposed to more structured extra-curricular activities, long-held family traditions changed. There was concern about the “latch key children” so named because they would come home to an empty house. The evening meal, often the only time in which the entire family came together, was often disrupted due to conflicting schedules. This led to the so-called crock pot families where the family meal was available to all who passed by…making it easy to just grab a bite and be on your way without any hassle (or conversation).

Forced Socialization in the Pew

Another effective defense against loneliness was the weekly church service. Traditionally, religious institutions encouraged socializing (and in some cases, demanded it). However, attendance at religious institutions has declined in recent years (one study says church membership in the U.S. has declined from 70% in 1999 to 50% in 2018).

 

WHY SO MUCH LONELINESS?

It is ironic that in this digital age when we have vastly improved modes of communication, that we would identify loneliness as a problem. Facebook’s founder, Mark Zuckerberg, insists that he saw his invention as a tool by which relationships could be fostered throughout the world and help dispel feelings of loneliness and dissention, but it appears that it has done more to promote divisiveness and distrust.

 

With the invention of the telephone we gave up non-verbal cues in our conversations, and the trade-off for its convenience seemed like a good deal. Now kids have largely given up talking on their cell phones in favor of texting. Voices from the internet, news media and politicians all conspire to promote divisiveness and paranoia to the point that it is almost impossible to have a rational conversation about many of the issues of the day.

 
Today people are marrying later and living longer. As reflected in the census figures of 2012, 32 million or 27% of Americans lived alone which was up from 17% in 1970. As you might expect, widowhood is likely responsible for many single occupant households, and in another study it was found that 47% of women over the age of 75 lived alone. With aging, comes the inevitable debilities and limitations. The National Institute on Aging reports that nearly half of all people over the age of 75 have hearing loss, which can be a major impediment to any meaningful social interaction resulting in withdrawal from friends and family.

 

It has been said that Americans are losing faith in our institutions, and our political leanings are often shaped by who we hate rather than who we like. Political discourse has hit a new low. Muck raking is no longer good enough, and has been replaced by personal insults a la grade school rants. Respect for contrary opinions has now gone out of fashion. Divide and conquer is the new strategy, and a tactic that seems to have even been adopted by the news media (Matt Taibbi has written an entire book about it, called “Hate Inc.”). We lack heroes. We frequently hear the term “disenfranchised” these days, a synonym for “left out” and to be an outsider is lonely for any herd critter.

ALL IS NOT LOST (stay with me…a little break from “downer” time)

There is some evidence that there may be some efforts underway to deal with the loneliness issue. I was pleased to see a recent article in Psychiatric News suggesting that psychiatrists are focusing more on loneliness as an underlying psychiatric problem (don’t know why it took so long to figure that out). A former president of the American Psychiatric Association has suggested that assessment for loneliness be part of any evaluation or perhaps become a diagnostic category in the DSM 5 (the shrink bible). There is also a growing awareness of a worldwide suicide epidemic which most would agree loneliness all too often plays a part.  Lonely lifestyles also frequently seem to be common with mass murderers.
lonely quote

LONELINESS VS. BEING ALONE

Proximity to other people is not necessarily a solution for loneliness, for it is not unusual to feel lonely in the midst of a crowd. Obviously, some type of emotional engagement is necessary to dispel lonely feelings. Ordinary discourse involves much more than words. Unfortunately, in our digital world many of the nuances of communication are lost. Not only are the tone, rhythm, volume, and timbre involved, but there are multiple non-verbal cues which can modify or even completely change a communication. As a matter of fact, some very significant interactions may occur without any words spoken. In that vein a text hardly measures up to a face to face encounter as a means to communicate feelings.

 

Emotional tone is less relevant, for even an argument can dispel lonely feelings.
Although, until recently, there have been few attempts to measure the extent of loneliness, there is definitely a consensus among sociologists and mental health professionals that there has been a definite increase. Employers have taken note of recent research which has shown that employees are more productive when they are encouraged to interact with each other. As a consequence, in many cases the traditional office cubical arrangement has been scrapped in favor of a more open environment, teamwork is encouraged, and brief chats at the water fountain are less likely to result in a dirty look from the boss. Since most workers spend nearly half of their waking hours in the workplace such changes could be very beneficial for large segments of society.

 

GO TEAM

The needs for engagement with other humans has long been addressed by the formation of millions of organizations that bring groups of people together with myriad goals, but which also provide an opportunity to relate to others. The sense of belonging to a group is a powerful antidote to loneliness. Young people who feel neglected or alienated are more likely to join street gangs (easier to radicalize for terrorism and/or recruit for “religious” cults*). Athletic events and concerts attract millions, most of whom “show their colors” and cheer as one. One of my all-time favorite TV shows was Cheers which identified the locus of the show as the place “where everybody knows your name.” Organizations of all kinds including sports teams, military, and political groups or for that matter any group of people with a common goal make use of the need to belong which at the end of the day is an antidote to loneliness.

THEY NEED EACH OTHER

AARP sponsors a very interesting and apparently successful program called “Experience Corps” in which volunteer over 50 are enrolled in a program where they are trained to help children develop literacy skills. They spend 6 to 15 hours per week working with K-3 students with spectacular results including as much as 60% improvement in reading skills, fewer behavior problems, improved attendance, and increased graduation rates  The AARP foundation at last report had 2,000 volunteers throughout the country serving over 30,000 students. However; it appears the volunteers may be benefiting more than the kids from the program. A University of Michigan study reported a statistical decrease in depressive symptoms and functional limitations among the volunteers after two years involvement in the Experience Corps. There may also be a secondary benefit in that some kids may learn to venerate rather than denigrate us old folks. (Score 1 for the Old Farts!)

 

BE CAREFUL WHAT YOU WISH FOR

None of this should be interpreted as an attempt to diminish the value of solitude. Certainly, this need to relate can be overdone, and in some cases become pathological. In many cases of marital therapy, for example, too much togetherness can be identified as the problem. In testimony before Congress, Prof. Julianne Holt-Lunstad defined loneliness as ” the perceived discrepancy between one’s desired level of social connection and their actual level of social connection.”  She explained that some people who are socially isolated don’t necessarily feel lonely, and some people who are lonely are surrounded by people who make them feel more alienated.

 

One’s work may require so much contact with others that it can become oppressive, and some personalities may cause anal pain of the worst kind!  Nevertheless; before you make plans to spend the rest of your life on a deserted island or join an order of non-verbal monks, be careful what you wish for. Time-alone can be refreshing, relaxing and creative, but as with most things in life, it can be overdone. Alone can be good, but lonely can be very bad. In this time in which we are all mutually dependent, it has become even more necessary to have relationships than we did in those days when we needed help to bring down a woolly mammoth. It is difficult nowadays to survive in this world as a loner. We face enormous problems including an increased global population, competition for resources, and degradation of our environment. It is once again time for us to hang together or hang separately.

WHAT MAKES THEM TICK?

The ability of the human race to relate to each other has allowed us to survive and to thrive.  We need to exercise that talent now more than ever.  As I finished writing this, once again two hate-filled young people described as loners committed horrible atrocities within hours of each other. It goes without saying that we need to take logical steps to limit access to those instruments designed to kill people, but the prevalence of these kinds of behaviors also require us to learn more about the milieu in which they occur.  For example: are there genetic influences involved, does our society in some way generate such hatred, are certain personalities more easily recruited to violent organizations, is shyness a precursor, and finally does the hatred cause the loneliness or vice versa?  We need to understand more about how these people end up the way they are if we are to have any success at solving the problem.

SEX ABUSE OF KIDS

SEXUALLY ABUSED KIDS
Last week I published a tongue-in-cheek response to an op-ed I had read in the editorial page of our local newspaper. The admonishment of the writer of the op ed that we should limit our talk about childhood sexual abuse stirred up some painful memories for me of patients who were attempting to overcome the effects of childhood sexual abuse.

A True Story
One case in particular comes to mind. This patient was an attractive young woman who came to see me with vague complaints and reported she had come because: “I just want something for my nerves.” After initial hesitation, she was able to give a more detailed history. Her general presentation confirmed my initial impression that she was suffering from clinical depression. She seemed shy and avoided eye contact until I asked if she worked, at which time she looked directly at me as if to assess my response as she hesitantly told me she worked as an “exotic dancer.” Apparently, I passed the test, for at that point, she unloaded in great detail how she had chosen such a career, and how she hated it.
She grew up in a blue collar family. Her father was a factory worker who forbade his wife from working. Her dad was a periodic, episodic alcoholic, and when drunk, was violent and abusive. When sober he was easily provoked. Mother was cowed, totally submissive, and seemingly helpless to protect her children from her husband’s rages. My patient (we shall call her Mary) along with her two older brothers developed strategies to avoid Dad when he was expected to come home drunk. As Mary grew into adolescence, her father began to take notice of her, and finally on the return from one of his nightly drunken forays came into her room and raped her.

But this was not the end of the abuse for the old man had the temerity to excuse his behavior by telling Mary that it was only because he loved her that he was sexually attracted to her. She accepted his advances as she was terrified at the thought of his beating her as he periodically did her mother.

Think it couldn’t get any worse?
Think it could’t get worse than this? Wrong. Soon her brothers emulated their father and to make matters even more unbearable bragged about having sex with her to their friends at school. As you might expect, this led to pursuit by many of the boys at school who were convinced that she was an “easy lay.” And where was Mary’s mother while this was going on? Mary was convinced she was aware, and attempted to convince herself that mother was so beaten down as to be rendered helpless, but she was also horrified to think that her own mother might have offered Mary up to her father in order that she would not be a target of his rages.
Emotional Extortion
Mary’s father had promised all kinds of dire consequences if Mary should ever breathe a word to any one about his behaviors. She knew that she would get no support from her mother were she to seek outside help. By now, even Mary’s teachers were convinced that she had become a problem as they heard that she was promiscuous. There was a reluctance to tell anyone due to the intense feelings of shame she felt about the incestuous relationships. There was also that long held custom of blaming the female in such situations, of which Mary undoubtedly was well aware.

The Spiral
The effect of all these prohibitions was made evident as she several times during the session asked for reassurance of confidentiality. In such a situation, the only sensible thing for her to do was run away, which is what she did. From then until the time of our session, her chronology was a bit hazy. I suspect that some pimp thought he had struck it rich when he discovered this beautiful little runaway. Although she did not admit to such, it seems likely she did engage in prostitution. In any event, at this point I felt it not necessary to probe deeper into her past for I had already seen enough pain to last for the rest of the day. It is enough to say that somewhere along the line she did find a way to use the only tool available for her to make a living in a semi-legitimate manner by swinging around a pole naked. Unfortunately, I never saw her again but noted the “men’s club” where she had been working was closed down by the sheriff. Her name was not listed among those who were arrested.

Sex abuse survivors suffer long after the abuse ends 
You may be thinking stories of this kind unusual, but they are not rare. It has been several years since that day I saw Mary, but I still think of her occasionally and wonder what her life is like now. I hope she found a good guy to marry has a couple of kids and is living happily ever after. But in my heart of hearts I know that is very unlikely. Those who have suffered such abuse usually have serious trust issues which interfere with the formation of meaningful relationships. Even though they know on a rational level that the abuse they suffered was not their fault, they often blame themselves by questioning whether the assault was brought on by their seductiveness, which is reinforced by the oft heard “she must have done something to bring this on.” They lack self-esteem, devalue themselves, and feel unworthy. When shown attention, they may be suspicious and distance themselves while others may become promiscuous, feeling they have nothing to offer other than sex. In their search for love, they find themselves in a series of abusive relationships a la the repetition compulsion which Freud so eloquently described.
Meanwhile, I continue to fuss over the op ed that I sarcastically commented on in my most recent blog. I was curious when I first saw the title of Ms. Flowers piece, but as I read on I became so angry that I could have had a Lindsey Graham type temper tantrum on the spot. I immediately wrote a rebuttal in my passive aggressive style, which Maggie thought was worthy of publication however; I feel the subject of child abuse deserves something more than a few smart-ass comments. I felt that Mary’s story speaks eloquently as to the effects of childhood sexual abuse. Fortunately, most cases are not so horrifying as hers, yet even less aggressive acts can have long lasting effects.

More light required
Yes, I was angry with the writer for her blame the victim tactic, and her concern about Kavanaugh’s “pain” but not one kind word about Dr. Ford. But the clincher for me was closing statement in Ms. Flower’s op ed in which she writes: “That we have now reached the point that assaulted children are considered appropriate conversational tender sterilizes the soul and induces a nausea that can’t be eliminated…”I submit that such an attitude is a major contributor to child abuse. For too many years as with Mary, most such vile acts which have robbed many children of their innocence often leaving them significantly impaired with a lifetime of suffering have been carried out in secret.
There has been some progress in shining the light on the problem e.g. there are now mandatory reporting laws in most states which require physicians, nurses, social workers, emergency rooms, psychologists, etc., to report their suspicions that a child is being abused, and yes that includes the sexual abuse which Ms. Flowers insists should not be a subject of “civil discourse.” It is also encouraging that many charged with caring and working with kids are being prosecuted, and that the veil of secrecy that has surrounded the violation of children by priests is being lifted. However, the National Center for Victims of Crime reports some very disturbing statistics which confirm sexual abuse of children remains a serious problem:

  • 1 in 5 girls and 1 in 20 boys is a victim of child sexual abuse;
  • Self-report studies show that 20% of adult females and 5-10% of adult males recall a childhood sexual assault or sexual abuse incident;
  • During a one-year period in the U.S., 16% of youth ages 14 to 17 had been sexually victimized;
  • Over the course of their lifetime, 28% of U.S. youth ages 14 to 17 had been sexually victimized;
  • Children are most vulnerable between the ages of 7 and 13.
  • 75% are abused by people they know and often those whom they trust
  • 23% of reported cases are perpetrated by kids under the age of 18
  • 40 to 80% of such juvenile offenders have themselves been victims

As we have witnessed in that infamous recent Supreme Court hearing, many of the old habits which allowed such awful acts to be inflicted on our children are still in place. The issue must not be swept under the rug as Ms. Flowers suggests but should be considered “civil discourse” of the highest order. Pedophiles do not feature a sign on their foreheads announcing their sexual proclivities therefore; those to whom we entrust our children deserve careful scrutiny. My own experience in that regard accentuates that truth.

Wolf in Sheep’s Clothing
He was a person for whom I had a great deal of respect. We first met when I was a psychiatry resident, and I was impressed with his knowledge and competence as a board-certified child psychiatrist with many years of experience in institutional practice with a University affiliation.

Upon completion of my residency, he invited me and a couple of other recent graduates to join him and form a group practice. Fortunately for me, I received another offer for later I was shocked to find he was sentenced to a lengthy prison term for child sexual abuse. He had apparently managed to abuse children, in most cases, who were residing in institutions, where complaints would likely be ignored. Of course, no one knows how many lives he may have ruined. In retrospect I realized I had missed all the warning signs.
Yes, it is my most ardent belief that the problem of childhood sexual abuse deserves serious attention and more “civil discourse” not less of it.

Transitions

This title was chosen by my son for reasons which will soon be obvious. His youngest has just left home, this time for good, and he and Sue are now presiding over the proverbial empty nest. It is a frequently quoted truism that if you truly love someone you will let them go when it is in their best interest to leave. I was reminded of this last night as I watched Casablanca…one of my favorite movies in which that theme was paramount. Though it is a noble act to let go of those you love, separation is painful, and usually results in significant changes in our lives.
We experience multiple types of transitions during our lifetimes, but since we are at heart social beings, or to put it more crudely, tribal in nature, changes in our relationships are apt to generate the most intense feelings. It is something of a paradox that as the world gets smaller, we find so many people of whom we care to be geographically farther away. Yes, indeed we are able to communicate with ease yet Facebook is a rather poor substitute for a next-door neighbor, or a relative living in the neighborhood. Prior to the industrial revolution, one’s cadre of friends and relatives was unlikely to change very much, and most people were born and died in the same place, often even in the same house. Now neighborhoods are in a constant state of flux, and there is a lower expectation of lifelong relationships.

STUCK WITH THEM
No wonder our children are among the very most important people of our lives. Since humans require nearly 2 decades to reach maturity and carry our DNA, we tend to form very strong bonds. We are often identified as “Johnny’s” father or mother. We live vicariously through them and share their triumphs, failures, joys, and sorrows. In many ways they are our second chance at life as we attempt to steer them away from repeating our mistakes. As the years go by our intimate involvement in their lives blurs with our own–they become part of us and in doing so shape our identity, i.e. who we are.
GRIEF WITHOUT A CORPSE
With all that in mind, it is not surprising that separation anxiety is a common affliction. When the kids grow up and leave, something more than their presence is missing. It is as if a part of ourselves is gone. Not only is the nest empty, but we feel an emptiness within ourselves, a kind of psychological amputation. In my experience, this emptiness is most profound when the youngest one leaves  for with it comes the realization that nothing will ever be the same. This time they are leaving to build their own nest.
THE FUN TIMES
Life is an ever-changing process. We begin as totally helpless and dependent creatures and experience a myriad of transitions during our lifetime all designed to produce an individual capable of building and presiding over that nest. Some of those changes are more dramatic than others. There are the first steps, the first words, the first solo bicycle ride, the first day of school, the first sleep over and a few thousand other adventures all with a goal of achieving sufficient independence to allow them to face the world on their own.
WHY DID I GET INTO THIS?
But it is not all sweetness and light. There is the messiness, the lack of discipline, the terrible twos, the out of bounds phase, the adolescent rebellion, the sleepless nights, and the continued testing of limits to name a few of the frustrations inherent in the child-rearing business. Those little buggers are also expensive. According to the USDA the average cost of rearing a child in 2016 was over $245,000 which does not include costs for higher education (but for the kids, I could have been a millionaire). Considering all the chaos they generate it is little wonder that we don’t occasionally wish them to be grown up however; one should keep in mind the maxim to “be careful what you wish for.”
BEGINNING AND END
According to the Bureau of Labor Statistics 67.3 % of high school graduates enrolled in college last year (2017). It seems safe to assume that most of these kids would leave home while in school, but retain a close connection to their old familiar environs. In many cases the college transition is a prelude and training for that final fly away. The days when we dumped kids and their gear off to a strange new environment were certainly memorable to Barb and me.
Our first experience with the off to college scenario was painful for all involved. Molly, our firstborn (now deceased), who suffered from serious medical and emotional problems was unable to complete that transition. Next in the line of succession was Peter, who was much too macho to display his feelings, but I was already missing him by the time we pulled away from his dorm. After a four-year hiatus, it was Trudy’s turn. Trudy, the adventurous one, was on the phone almost immediately, tearful and very upset to find beer being consumed at the sorority rush parties that she attended. We had no idea where this came from for temperance had never been emphasized at home. As you probably already suspect. her distress was short lived and as was her habit she soon became involved in everything.
THE LAST ONE STANDING
Of course, those separations were painful, but none so telling as Maggie’s departure for we were now returning to a house inhabited only by Barb, myself and Grover the dog. Maggie was one who had insisted on an out of state school, for she was eager to assert her independent status. She wanted distance from childhood connections. Her reaction to the college transition was a convincing testimonial for that “be careful what you wish for” thing. Permanently engraved in my memory is the sight of that sobbing, skinny little red-haired girl who stood there all alone in that huge empty parking lot making feeble attempts to wave goodbye as we pulled away. Barb wanted to go for one last hug, but I insisted she had already had several last hugs. We were later told that she cried for the next month and lost 20 pounds. [See an earlier blog post about Separation Anxiety + Mental Health}
NOT ALL SWEETNESS AND LIGHT
In case you are thinking this gang of mine is the Partridge family incarnate, think again. It is true that to date we have come through our transitions relatively unscathed, but not without trials and tribulations. In spite of their best efforts some families are overwhelmed by circumstances beyond their control. Barb and I are indeed fortunate that in spite of our screw-ups we have ended up with 2 generations of exceptional people, and the beat goes on.
STILL AT IT
It so happens that this month marks the beginning of significant transitions for every one of my Grandchildren which of course they will undoubtedly handle better than do their parents (or Grandparents for that matter). My three oldest grandchildren are already emancipated and starting new and more challenging jobs. Another is off to her first year in college, and our youngest is entering high school. As mentioned in my opening statement, Carter’s room is empty, and home is now in another city far away. Trudy’s is the only nest still occupied.
LIFE GOES ON
Whatever distress the kids may feel from leaving those years of memories behind is apt to be short lived compared to that of their parents. There is hope for Mom and Dad however. In return for enduring the vicissitudes of child rearing God has rewarded us with grandchildren. Thus, we have an opportunity to get all the goodies and none of the crappy stuff ,which leaves me wondering what it would be like to be a great grandparent. Stay tuned for the answer!

THAT MOTHER THING

These days, it is difficult to forget Mother’s Day as there are plenty of reminders on TV, radio, newspapers, billboards, and now even the internet.  Although the holiday (it even seems disrespectful to call it that) has been a boon to florists, candy companies, and greeting card businesses, it also generates a type of sentiment not found in other celebrations.  According to Mr. Google, there have been times set aside to venerate mothers and motherhood since ancient times, but our modern version is said to have its origins in Grafton, West Virginia in 1908, when Anna Jarvis promoted the idea of a day to honor mothers. She was soon to be disappointed when the day which was sacred to her became commercialized.  Anna spent the rest of her life attempting to correct the image which she felt dishonored her Mother, and died penniless in an institution.

DON’T MESS WITH MOM

We are all aware that motherhood is necessary for the propagation of the species, but the relationship between a mother and her offspring is like no other.  Mothers will fight to the death and endure any amount of hardship to protect and nurture their offspring.  This is true for most of the animal kingdom, but especially for humans.  Most animals who have live births nurture their young until the kids are able to make it on their own, but human moms never stop mothering.  You might think since they are around for a couple of decades it might be that they simply become like an old pair of shoes which you don’t like to get rid of, but there seems to be much more to it than that.

Back in the old days, when country doctors did pretty much everything except major surgery, I delivered a lot of babies.  Many times I would hear my patients in labor crying out that they would never go through this pain again, but when that baby was delivered into her arms the room would brighten with her smile.  The ordeal of birthing would soon be forgotten and often at the six weeks checkup there would be talks of having another child.  The mother of my children describes her feelings of holding our babies as a feeling of joy which she could not find words to describe.

Screen Shot 2017-05-13 at 8.30.46 PM.png

Kids do grow up and leave the nest, but they carry a piece of Mom with them for the rest of their lives.  No one or no other relationship will have such a profound effect on their lives.  Without nurture, it has been shown that children will grow up with significant deficits similar to those seen in Harlow’s monkeys when they were deprived of maternal contact.  With that in mind, it seems clear that mothers’ roles involve much more than merely giving birth and providing sustenance.

When children are born, they have no sense of who or what they are.  One can see an infant at times appearing to discover his toes and other body parts.  Likewise, in their early years, they will need help to develop an identity, and to do so, they will depend upon those with whom they spend the most time. However, perhaps the most important issue they learn concerns their lovability.  In my practice, those who felt as if they were unlovable were among the most unhappy.  They found it virtually impossible to establish meaningful relationships.  They lacked self-esteem, often to the point of self-loathing; consequently, they were vulnerable to exploitation of all kinds.  They were often used and abused, which they felt they deserved.  This opinion of self, which appears to have its origins in childhood, resists change and seems to persist throughout life even when told their picture of themselves is inaccurate.

ALL YOU NEED IS LOVE

Obviously, the only way one can know they are lovable is to be loved, which brings us back to the subject of mothers.  Traditionally, they are the ones in charge of loving.  Their love is constant, unremitting and lifelong.  They continue to love even when their children are total jerks or perpetrate the most dastardly of deeds.  It has been said that a father’s love is conditional.  I have always resented that characterization, for I felt I loved the kids as much as did Barb, yet I must admit that her capacity for forgiveness and tolerance exceeds mine.  After all, I was only an observer and not a participant in their entry to this world.

If you think mothers are lovers, take a look at grandmothers.  With the responsibilities of teaching kids manners, discipline and societal survival skills gone, there comes an avalanche of unimpeded love.  For me, grandparenthood has been an opportunity to enjoy the kids without feeling any responsibility.  I have concluded that grandparenthood is God’s reward for enduring the vicissitudes of parenthood.

It is true that in the past mothers have received a bad rap from we psychiatrists.  Mothers have been accused by us of causing everything from autism to homosexuality.  This fad began with Freud, who attempted to unravel some of the mysteries of early childhood.  Although his work provided an impetus to learn more about the effects of childhood experiences on later life, many of his conclusions have been discredited.

IT DOESN’T GET EASIER   

In the past, motherhood was a full time job.  Although mothers would engage in activities outside the home (my grandmother helped with the milking), their primary function was to care for their families.  Today’s mothers amaze me in that a majority of them also have full time jobs outside the home.  That puts an exclamation point after the time honored phrase “woman’s work is never done.”  Granted, fathers are now more involved in domestic activities than in the past, but I seem to remember reading something about a study that indicated the duties of the woman of house have changed little over the years.  Without our so-called modern household conveniences, it would probably be impossible for the hardiest of souls to accomplish what these warrior mothers do.

However, the most amazing mothers, to me, are the single moms who take on the total responsibility for feeding, clothing, teaching, disciplining and loving their children.  The fact that many single mothers accomplish this without any outside help is inspiring, especially when one considers the number of kids who grow up to be good people.  Unfortunately, these mothers are often derided rather than praised.

THEY AREN’T ALL MUSHY

You should not be surprised to learn that I too had a mother.  She loved me for no good reason that I could fathom, and I loved her too (although I would never admit it when I was growing up).  Mom was not a hugger.  She was a patter—i.e. when she was glad to see me, or pleased with something I had done, she would wrinkle her nose and pat me on the arm or shoulder a couple of times.  I suspect this was a result of her childhood, for her family was not demonstrably affectionate and never wanted to be “showy.”  She was a great cook and enjoyed feeding us.  In later years, a visit would see her “throw together some leftovers” with little obvious effort, and they would always be delicious.  I was a child of the Depression and barely recall my parents on occasion telling my brother and I they wanted us to eat first.  It would be years later before l realized why they did that.

SUPER MOM

It has been my good fortune to meet and marry someone who was born to nurture, and I have watched her in action for quite a few years.  When we were married, she announced that she wanted to have four children.  I thought two would be plenty, so we reached a Barb-type compromise and had four.  Since they were all exceptional from the very get go, I agreed to keep them all.  It was a good decision.

As with most mothers, Barb continues to exude love from a reservoir that never runs dry.  Every now and then, she will reminisce about those days when she had them all fed, bathed and tucked in, and how she felt “so rich.”  When we see a baby in the grocery, she tells me how she would like to hold it.  If there is a young one in a restaurant, she will approach the mother ask its age and tell her how beautiful is her baby (she seems to have never seen an ugly one).  Those tear jerking ads on TV featuring small kids do a number on her.  She insists were she a little younger she would adopt some of those starving African kids.

As for the grandchildren, don’t ask unless you have some time to spare.  It takes a while to tell you how wonderful they all are, but you will be able to see those tired brown eyes come to life.  Like it or not, you will probably also hear the complete package which includes their parents who are also “above average.”

SHE WILL JUST SAY YOU SHOULD SAVE YOUR MONEY 

Meanwhile, it is nice to send your mother flowers and stuff, but all she really wants from you is love.  She deserves all you have to give.

HOW MUCH ARE KIDS WORTH?

Tragedies involving children always get a lot of press, and the most recent example concerned a school bus accident in Tennessee in which six children were killed. In such cases, there is usually a search to determine who was at fault, and this was no exception. If an act of human negligence is found to be the cause, we can add outrage to our feelings of sadness and horror. The headlines become larger, and blaming reassures us that there is someone out their more careless and uncaring than ourselves.

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NOT MY FAULT
In such cases as this, we only need to look as far as the nearest mirror to see who is responsible. It is true that there were warnings about this driver, which should have been enough to prompt his removal from such an important job; however, no action was taken. In such cases, should responsibility not be shared by those who have the ability to prevent such a horrendous tragedy? We profess that these bus drivers carry our most precious cargo, so should they not receive the highest level of scrutiny? Qualifications for school bus drivers vary widely from state to state. Pennsylvania requires considerable classroom and on-the-road training, physical and mental evaluations, and extensive background checks, while my state (Ohio) requires only a commercial license with passenger designation. I suspect that Brink’s truck drivers may be more highly trained and investigated. After all, they are carrying money.

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WHY?
There was a school bus accident in my county six years ago, and 7-year-old Kacey was killed. Video from the inboard surveillance seemed to show that the driver had lost consciousness. I was surprised to learn that in our state, school buses were not required to be equipped with seat belts. This made no sense to me then, nor does it now. Since 1968, I have been required by law to fasten my seat belt, yet our children are left to fend for themselves in a large, top-heavy, tin can mounted on a truck chassis. Following the accident, there was talk by our state legislators of requiring seat belts, but, as is often the case with politicians, they were long on talk but short on action. After reading that the bus in Tennessee did not have belts, I inquired at my local school board office to find out about the status of the seat belt issue and was told that our buses still do not have any physical restraints. When I asked why, I was told that the state had not mandated them yet (not an adequate answer in my opinion).

ARE YOU SERIOUS?
The latest information I could find on the subject was that only six states mandated seat belts on all school buses. The National Highway Traffic Safety Administration (NHTSA) does not require or recommend seat belts on all buses weighing more than 10,000 pounds. They concluded that “the crash forces experienced by occupants of (heavier) buses are much less than that experienced by occupants of cars, light trucks, or vans.” Could this mean that my 10th grade physics teacher was “full of it” when he gave us that force formula f=ma?

The NHTSA has initiated a concept they call “compartmentalization,” which they insist offers superior protection in crashes. Protection is offered by the use of high seatbacks which are highly padded, and designed to absorb the shock of a frontal crash. Crash tests confirm their effectiveness in head on crashes. NHTSA in 2002 testified in Congress that seat belts were unnecessary, pointing out that school bus travel was the safest form of ground transportation available. Indeed, their statistics are impressive when one considers 440,000 school buses travel 4.4 billion miles each year carrying 24 million kids with only six fatalities.

FOLLOW THE MONEY
Studies by the University of Alabama in collaboration with NHTSA concluded that “the cost of installing seat belts on every bus is prohibitive.” They estimated that it would cost $8,000 to $15,000 per bus. The studies also concluded that schools would need to increase their bus fleets by approximately 15% due to space requirements for belts with a total cost of $117 million per state. Their final opinion was “costs far exceed benefits.” That and similar statements undoubtedly lead a group like The National Coalition for School Bus Safety to say the issue is influenced by “an economically driven industry.” These statements also lead us to the question: how much are we willing to pay for a few kids’ lives?

DAD DESERVES A MEDAL
In December 2010, Today.com reported an accident in Texas similar to both the recent one in Chattanooga and the one that happened in my town. In 2006, a Texas school bus carried a high school girls’ soccer team when it was forced off the road into a ditch and rolled over. One girl was thrown through the window, and her arm was pinned under the bus, resulting in serious injury. Two other girls were killed, and there were other less serious injuries.

One of the fathers was convinced that a seat belt would have saved his daughter’s life, and he vowed to do all he could to see that all school buses would be equipped with seat belts by law. The Texas A&M Transportation Institute reached the same conclusions as had the University of Alabama, but, in spite of those objections, the law passed largely due to four years of continuous lobbying by the victim’s father. There must have been some buyer’s remorse, for the funds designated for the project were immediately cut by two thirds. I have no recent information about the status of the law’s implementation.

THEY ARE TOP HEAVY
The thing these nine children have in common is that they all died in a school bus that flipped. The design engineers who invented the “compartmentalization” strategy to prevent injury must realize that Ike Newton was right about that gravity thing; therefore, if a “compartment” does not have a lid on it, the contents are likely to fall out and scatter every which way when it is turned upside down.

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We will never know if seat belts would have saved Kasey or any of those other kids, but we do know that compartmentalization did not work for them. There are instances recorded that imply lives would be saved with seat belts. School administrators in districts where seat belts are used also report fewer problems with driver distraction, bullying and disciplinary problems.

Another unanswered question is to what effect the addition of seatbelts could have on reducing non-fatal injuries. The Ohio Department of public safety reported 1,590 school bus accidents last year, resulting in 282 injuries. I could find no information as to the seriousness of those injuries.

SIX DEATHS TO SEE A PROBLEM?
The only good news resulting from the Tennessee tragedy is that it has reawakened the debate about school bus seat belts. The NHTSA has reversed their position and now favor seat belts for school busses. Administrator Mark Rosekind is quoted in an Associated Press release that, even though school busses are the safest means of transport to and from school, “they could be safer.” The good news is that he has strongly recommended a national initiative to require lap and shoulder seat belts since November 2015; the bad news is that no action has been taken in that regard.

The last directive by the NHTSA regarding seat belts was in 2013, when a policy was implemented requiring new buses be equipped with seat belts with two exceptions: namely, transit busses and, you guessed it, school buses. I, for one, was incensed to read that the powers that be prioritize the safety of passenger buses above that of children, but, in spite of the good words by Mr. Rosekind, that policy appears to still be in place.

MORE TALK
Just a few days ago Mr. Rosekind once again voiced his unequivocal support for seat belts. He was convinced that school bus seat belts had saved lives and that others could have been saved if protected by belts. He went on to estimate that 70% of school bus deaths could have been prevented by seat belts. Nevertheless, despite the mountains of data that have been collected, he declined to issue a directive and planned more study of the subject. A major concern was how to finance such a program, and he even suggested that some school districts might need to be exempted from the requirement for financial reasons. Once again, money appears to factor in to a life-or-death decision.

According to a report in the November 28 issue of People/Crime, five days before the Chattanooga accident, one of the elementary student survivors wrote the following: “the driver was doing sharp turns and he made me fly over the next seat. We need seat belts.”

Out of the mouths of babes!


Note from the editor:

I found this topic particularly interesting, so Eshrink and I compiled a list of some articles for further reading.

Data and Statistics of School Bus Fatalities Over Ten Years

USA Today Article