the consequence of fear and ignorance

 

I was going to try to avoid writing about anything political this week, but I couldn't help myself. This blog is about the role storytelling plays in the practice of medicine, including the stories that describe our patients' experiences and the stories we recount as health care providers. I'm afraid the narrative is about to change, though, as we witness efforts to discontinue public health programs and dismantle medical research initiatives. Meaning that people...children...will die.

"The two public health interventions

that have had the greatest impact

on the world's health are 

clean water and vaccines."

~World Health Organization~

I've been around long enough to have celebrated the triumph of vaccination against polio, make that "paralytic polio", a disease you do not want to see, treat, or God forbid, suffer. We are already witnessing an uptick in cases globally, not because the vaccine is unavailable (yet...), but because RFK is spearheading efforts to withdraw funding from Gavi (the Vaccine Alliance, or Global Alliance for Vaccines and Immunization) whose purpose it is to fund immunization programs in underserved populations around the world. Trouble is brewing.

Closer to home, disinformation has bred skepticism and fear. Parents are hesitant to provide their children with even routine vaccines that have been proven safe and effective for many years. We have already seen an upsurge of measles cases among the unvaccinated that have claimed the lives of three otherwise healthy children.

Count yourself fortunate if you have never watched a young polio victim struggle to use crutches, much less fight to breathe in an iron lung. We thought those days were behind us. Now, we can't be sure.

The stories we have enjoyed for years may be changing. We may be going backwards.

"Universal vaccination may well be

the greatest success story

 in medical history."

~Michael Specter~

I can tell you the story of an otherwise healthy child who came home from school one day with a headache and a slight fever...and died the next day of meningococcal meningitis. That fast. Back in the days before we had a vaccine that would have prevented it.

I can tell you what it was like to treat a child with measles encephalitis and watch them die of a totally preventable disease or suffer its consequences for the rest of their lives.

I can tell you how hard it is to intubate an infant who is struggling to breathe with whooping cough or a toddler with epiglottitis, diseases we never see in vaccinated children anymore. 

Without a doubt, the stories we tell and those our patients tell will change given the present leadership of the Department of HHS. From triumph to heartbreak. From hope to despair. From success to defeat.

Trust me: you do not want your child, or grandchild...or ANY CHILD...to suffer or die from a preventable disease. You don't want ANYONE to die of a preventable disease because of skepticism, fear, or ignorance. If you agree with me, please make your thoughts known at:

Contact Us | HHS.gov

The US Department of Health and Human Services

Hubert H. Humphrey Building

200 Independence Ave., SW

Washington, DC 20201

1-877-696-6775

"To fear what you do not understand

is to mistake ignorance for safety."

~Ginn Hale~

jan

survival 101

This may not sound like a political rant, but it is. It's about surviving the news that greets us every day...coming from a man who is totally out of touch with reality, but nevertheless, has been entrusted with our nuclear codes. Scary thought. 

This is about loss of environmental protections, the eradication of public health initiatives and medical research (just when we are on the path to treatment of cancer with mRNA vaccines...), and the elimination of programs to protect the safety and purity of the water and food we have always taken for granted. It opposes gun violence. It is a call to alarm as the economy crashes, the military marches into our own cities, and human rights are dismissed with a shrug of someone's shoulders. It is a reminder that cruelty, arrogance, and greed are alive and well on Planet Earth.

"Deliberate cruelty is not forgivable.

It is the one unforgivable thing,

in my opinion."

~Tennessee Williams~

How are you coping with it? Are you worried? Scared? Disgusted? Angry? Depressed?

You could be experiencing all of those feelings...but still, you don't have to be consumed by negativity. I would recommend you try what I like to call "fierce mindfulness." It has been especially helpful to me this past week. If you already practice mindfulness meditation, you are ahead of the game. If not, this is a good time to start. You'll wish you had as the situation worsens...

For me, fierce mindfulness is an act of countercultural resistance, a refusal to succumb to the threats to our safety, well-being, and peace that are imposed on us by people who claim to be in power. Billionaires. Politicians. Liars and cheaters. You know who I mean.

I focused on mindfulness many times this past week. When the president announced his plans for a new White House ballroom. When RFK dismantled research into mRNA vaccines. When the military was deployed to the streets of Washington, DC. I could go on...

Here's how I did it. While other people fretted, or ranted, or chose to ignore the news and carry on as if nothing were wrong, I simply turned my attention to my very own senses, right where I was, in the moment. I focused on what I was seeing in the moment. What I was hearing. How the air around me felt. Which added up to something like this, most days: The sky was clear blue and cloudless. The air, warm. The breeze, gentle. I asked myself, "What more could I want? What could be better than this?" The chaos, the cruelty and injustice, the suffering of the entire world did not cause a ripple in my reality at the moment. In most of my mindful moments, in fact.

"You are the sky.

Everything else is just the weather."

~Pema Chodron~

When we surrender to worry, dread, anger, and fear we give them power over us. We bow to the enemy...but we don't have to. We can turn our attention inward. We can focus on all the ways the universe supports us. With intention, we can always find something to feel grateful for. Something that embraces beauty and peace. Something that heals us. Just a few minutes of respite from the craziness reminds us that there is hope.

"Resistance is feasible even for those 

who are not heroes by nature,

and it is an obligation, I believe,

for those who fear the consequences

and detest the reality of the attempt

to impose American hegemony."

~Noam Chomsky~

jan

how you can provide a safe harbor

 

A while back (see "take this test", November 23, 2021) I wrote about the Adverse Childhood Experience survey, something we were never taught about in medical school despite the fact that a growing body of evidence supports the link between childhood trauma and the development of physical disease and mental health disorders later in life. Childhood trauma includes physical, emotional, and sexual abuse, physical, verbal, and emotional neglect, living with a depressed, mentally ill, or addicted parent, witnessing domestic abuse, and losing a parent to separation or divorce...among others. Chronic adversities like these actually change the architecture of the child's brain, altering the expression of genes that control stress hormone output. This triggers an overactive inflammatory response that can lead to adult disease states, notably autoimmune conditions like lupus and rheumatoid arthritis, heart disease, and PTSD-like anxiety and reactivity. These long-term effects should compel all of us to take the problem of childhood trauma seriously. We should do all we can to identify it, prevent it, and mitigate it.

"You can spend a lifetime

trying to forget a few minutes

of your childhood."

~www.HealthyPlace.com~

This week, I came across another interesting issue that I was never taught about. It has to do with attachment disorders that arise in infancy and early childhood and how they affect health in adults, notably the same kind of autoimmune, cardiovascular, and psychological problems that childhood trauma does. Issues related to childhood attachment will be reflected in adult personality traits, behavior patterns, and relationship difficulties. Repression of anger is especially harmful. 

It turns out that there is a method for uncovering some of these issues in our patients. It is called the Adult Attachment Interview, or AAI, a twenty-question survey that is designed to explore how infants become attached to their parents...or not.

This is it:

Adult Attachment Interview (AAI) (George, Kaplan, and Main 1996) 

The AAI Questions:

1. To begin with, could you just help me to get a little bit oriented to your family—for example, who was in your immediate family, and where you lived?

2. Now I’d like you to try to describe your relationship with your parents as a young child, starting as far back as you can remember.

3–4. Could you give me five adjectives or phrases to describe your relationship with your mother/father during childhood? I’ll write them down, and when we have all five, I’ll ask you to tell me what memories or experiences led you to choose each one.

5. To which parent did you feel closer, and why?

6. When you were upset as a child, what did you do, and what would happen? Could you give me some specific incidents when you were upset emotionally? Physically hurt? Ill?

7. Could you describe your first separation from your parents?

8. Did you ever feel rejected as a child? What did you do, and do you think your parents realized they were rejecting you?

9. Were your parents ever threatening toward you—for discipline, or jokingly?

10. How do you think your overall early experiences have affected your adult personality? Are there any aspects you consider a setback to your development?

11. Why do you think your parents behaved as they did during your childhood?

12. Were there other adults who were close to you—like parents—as a child?

13. Did you experience the loss of a parent or other close loved one as a child, or in adulthood?

14. Other than any difficult experiences you've already described, have you had any other experiences which you should regard as potentially traumatic?

15. Were there many changes in your relationship with your parents between childhood and adulthood?

16. What is your relationship with your parents like for you currently?

17. How do you respond now, in terms of feelings, when you separate from your child / children?

18. If you had three wishes for your child twenty years from now, what would they be? I'm thinking partly of the kind of future you would like to see for your child I'll give you a minute or two to think about this one.

19. Is there any particular thing which you feel you learned, above all, from the kind of childhood you had?

20. What would you hope your child (or, your imagined child) might have learned from his/her experiences of being parented by you?

It requires some training to use this interview effectively; the questions require more than a yes or no response. It requires the provider to assess not only what the patient says, but how they express themselves, for example whether they respond fluently or haltingly, in detail or with a paucity of words, consistently or with frequent self-contradiction. 

The interesting thing about it is this: when the interview is conducted even before a person has a child, it can predict the attachment style they will develop as a parent: secure, avoidant, ambivalent, or disorganized. This, in turn, can raise concern for future problems with health and well-being as an adult, possibly paving the way for early intervention.

The point is that, as health care providers, we rarely have the time or expertise to explore these issues with our adult patients, much deal with them in treatment. How, then, can we help them heal?

"Give me your past,

all your pain,

all your anger,

all your guilt.

Release it to me and

I will be a safe harbor for the life

you need to leave behind."

~Jewel E Ann~

jan