Our remedies oft in ourselves do lie

I sometimes wonder if in another life I was actually a woman –perhaps in one of those what-if lands that we whisper to our children as they are nodding off to sleep. A place where roles are not so much reversed as fluid –changing as necessary, dissolving when needed. Not a perfect place –even a child expects some inequalities, some inevitable disputes- but a place where things even out in the end. Where disagreements are resolved, and fairness, like dust motes in a sunny room, coats even the darkest corners if you decide to look.

And why a woman? In this heavily gendered world, why would I espouse the mysterious side –the other side- when, for now at least, I find myself in an advantaged role? Why, if I have never entertained the idea in any but an intellectual sense, with no real desire to change my here-and-now, nor any wish to partake of other than a thought-experiment, would I think that in a once-upon-a-time story, I might have been what I am not?

I suppose, in part, it is because of the inequities to which many of us with a Y chromosome have so successfully adapted -swept under the carpet in our attempts to fashion the world in our own image. Like the sound of traffic that becomes barely noticeable to city dwellers, we have become myopic to all that isn’t immediately relevant to our own vicinity -our Lebenswelt. And it just seems so unfair.

I don’t want to sound too naïve in my jeremiad, too Pollyannoid in my expectations, but I do expect actions to be judged by what they achieve, not by who performs them. I do not expect a litany of excuses, or worse, a denial that excuses are even necessary.  As a recently retired obstetrician/gynaecologist, perhaps I am overly attuned to the denizens of my former world, but I find myself disheartened by examples of their contributions being overlooked, or at least undervalued. An article that I came across one day, outlined some of the problems: https://theconversation.com/womens-ngos-are-changing-the-world-and-not-getting-credit-for-it-88360

It discusses the role of non-governmental organizations (NGOs) in various countries –although this article specifically examines women’s NGOs and their work in India and Tanzania. ‘NGOs work with governments, community groups and the private sector — to develop and implement programs, monitor and evaluate their progress and help train people working on those projects.’ It would seem that these ‘[…]women’s NGOs played crucial roles in development projects, often mobilizing, organizing and building projects that otherwise would never have launched.’

In India, for example, ‘Women’s NGOs also conducted research to determine whether local communities could afford to pay for basic urban services. They negotiated subsidies, fair pricing and flexible terms of payment with utilities on behalf of marginalized people. They arranged access to loans from micro-finance institutions for households that could not cover the cost of water or electricity connections. And by insisting that water and electricity bills be issued in the names of female heads of households, women’s NGOs strengthened women’s access to property and housing.

‘The NGOs also educated stakeholders about the realities of life for the urban poor, and shared lessons learned in one urban area with NGOs in other cities in India.’

But, the success of their interventions often led to the marginalization of the NGO’s role in whatever successes they’d achieved. ‘[…] women’s NGOs had made vital contributions to the success of development projects, but they were easily marginalized and trivialized once those projects got off the ground. In India, after the success of the pilot projects, the other partners declared that they would “go it alone” and no longer involve the NGO partner in delivering basic urban services.’ Of course, the idea is to encourage self-sufficiency so the NGO can back away, but in many situations, their contributions, as women, were minimized in favour of the usual power brokers. ‘Although the contributions made by the women’s NGOs were critical to the existence and success of the initiatives, they were often dismissed as supplementary and dispensable by the other partners. Because the NGOs’ role of organizing, mobilizing and helping local communities participate in development initiatives was seen as a “natural” extension of women’s care-giving work, it was easy for other partners to diminish and dismiss their contributions. And because the other partners did not fully appreciate the contributions of the women’s NGOs, they were unwilling to share credit for the success of the project.’

The authors -Dr. Bipasha Baruah, Professor & Canada Research Chair in Global Women’s Issues, Western University and Dr. Kate Grantham Research Associate, International Development, McGill University- suggest  some strategies ‘to strengthen and validate the role of women’s NGOs in development partnership projects: A memorandum of understanding (MOU) that defines the specific roles and responsibilities of each partner should be an essential requirement for multiple-stakeholder projects. The lack of such formal agreements entrenches the perception that the role NGOs play is not particularly valuable.’

Call me naïve, but it is dismaying, to say the least, that such formalities are required to validate a helping hand -almost like requiring a contract be drawn up before helping someone cross a busy street.

And yet, as the authors point out, ‘It’s unfortunate they must “justify” their long-term involvement in such initiatives, but it may be incumbent upon them to make their contributions to the project more visible to the different partners and to the development community at large.’ And perhaps more especially, ‘[…] the specific challenges and opportunities that NGOs working on gender equality, or those that define themselves as feminist NGOs or women’s NGOs, face — when participating in multiple-stakeholder projects.’

Okay I understand, I guess. Let’s see… Outside agencies have to help women help each other, because otherwise the communities will forget who helped them. No, that can’t be right… Okay then, outside agencies have to publicize the fact that women are able to help… Uhmm, no? Well then, how about the agencies claim credit for facilitating the things that women have been doing for millennia…

I’m clearly getting old and cloistered in my years. Many of those things I had once assumed were self-evident, I now find were merely wide-eyed hopes -inexperienced beliefs, as devoid of truth as the fairy-tales I told my children. I have obviously not tasted all that I am supposed to sample despite my age –and yet, I still believe that help knows no gender. Goodness is not biased, nor is succour credited only to those crowding around and pointing at themselves when the patient is finally ready to be discharged.

But, perhaps I read too much poetry, too much Kahlil Gibran, when I was young; perhaps you cannot believe poetry; perhaps it is simply not enough –even if it speaks truth to power:
‘there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; they give as in yonder valley the myrtle breathes its fragrance into space. Through the hands of such as these God speaks, and from behind their eyes He smiles upon the earth.’

 

 

 

 

 

 

 

 

 

 

 

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Is Man a Piece of Work?

You see it all the time, don’t you –portrayals of great male warriors triumphing over equally determined rivals, their muscles rippling with sweat, their eyes scanning the crowd daring any others to step forward. It is a classic scene, presumably so reminiscent of the glory days of yore when men were really men –a classic depiction of a decidedly monolithic world where pursuit of power alone determined ethics and values. Where might was not only right, it was also appropriately so. What else could drive a nation, a culture, a belief, to success?

And what about those of us not favoured with bulging muscles who either could not, or would not compete in the marketplace of war? We wore the yoke –the etymological root of subjugation.

Although largely undisputed, I have always felt that this view of history was probably a victor’s view: partial, and likely doctrinaire. Perhaps even unrealistic. And yet a reading –or nowadays, more likely a movie portrayal- of the classic heroes would do little to disavow this opinion. Every so often, though, there seem to be other, quieter voices crying in the growing wilderness of masculine insecurity that cast doubts on the impenetrability of the foliage. Voices that find paths hidden in the woods.

‘Homer’s Iliad has been used by some men to hail the virtues of traditional masculinity in the 21st century. Typically, the famous work of literature serves as a sort of manual of manliness. […] Aside from longing for the (grossly misunderstood) glory days of a triumphantly Christian Europe that traced its heritage to the Greeks and Romans, the new champions of the West obsess over an idealized version of the past that bears little resemblance to the real Greece and Rome.’ https://theconversation.com/toxic-masculinity-fostered-by-misreadings-of-the-classics-88118 -This from an article in the Conversation.

‘The classical world furnishes us with examples of manhood, masculinity and heroism that have inspired some men to react against the supposed feminizing of Western culture, especially in the university setting.’ But, as one might expect, the reality was likely far more nuanced than its adherents would have us believe.

The article’s author, Matthew Sears, Associate Professor of Classics & Ancient History, University of New Brunswick, uses Homer’s Iliad, a classic tale about the Trojan War, as an example. He says that when he first read it, ‘[…] the final showdown between the opposing heroes Hector and Achilles [was] an utter letdown. Hector, in fact, runs away rather than face his opponent. Only after Achilles has chased Hector around the walls of Troy three full times does Hector turn to fight, and only then because the goddess Athena tricks Hector into thinking that a Trojan ally would be by his side.’

This seems to glorify the strength and reputation of Achilles, of course, but also denigrates Hector, the Trojan hero. But more interesting –to me, at least- ‘By using different Greek words for manliness, Homer distinguished between Achilles’ toxic masculinity and appropriate expressions of manliness.’ I’ve left the link in for readers who may wish to pursue this further. ‘Readers do, however, tend to recognize in Hector, the greatest Trojan warrior, a far more sympathetic figure, embodying classical manhood by fighting bravely and selflessly for his city and family against impossible odds and an implacable enemy.’

And yet, this is still a masculine trope, albeit a different variety, isn’t it? No, Hector doesn’t win, but he fights for what he believes in against impossible odds… A real man, although not a victor like Achilles. But wait -the complexity increases! ‘Not only does Hector’s nerve fail him at Achilles’ final approach, […]the Trojan prince waits outside the safety of the walls not because of any higher principle or courage. Rather, he waits because he has made the mistake of not ushering his soldiers into the city much earlier, which would have spared countless men a grisly death at Achilles’ hands. Hector must therefore save face lest some lesser man chide him.’ –Things fall apart, the center cannot hold, in the immortal words of Yeats.

‘Before fleeing, Hector also ponders whether he should lay down his arms and attempt to strike a deal. Instead of fighting to the death, Hector considers offering Achilles not only Helen and the treasures she brought to Troy, but every last ounce of treasure in every last household in the city, effectively selling out all the Trojans instead of facing death himself. Only after deliberating over these two options does he turn to run.’

But doesn’t that make Hector more of a person, not less of a man? As Sears puts it, ‘Aren’t we all guilty of taking a stand when it’s easy and when we’re among friends, yet balk at the chance to speak out when there might be real repercussions? […] From the gut-wrenching fear and indecision in Hector’s breast, to the plaintive laments of his father, Priam, as he begs his son to come inside the city walls […] the heroes of Greek epic are terrible fodder to use to justify […] toxic masculinity.’

It seems to me that there is a current of fear raising the hackles of many men nowadays. In this age of mirror-speak, many fear not seeing what they expect. What they deserve. Every unwelcome reflection is too easily mistaken as historical revisionism –that the attribution, for example, of the relative lack of contribution of women in history, is related not to its suppression, but rather to its absence. And for many, I fear, that the recording of history has largely been the preserve of men, seems unimportant. Merely an excuse, to delegitimize the world view it wishes to espouse.

So, have I become a modern day Judas, selling out my side, if not for money, then out of weakness? Someone not ‘man’ enough to oppose the feminizing of Western culture, to speak out against political correctness –or worse, who agrees with it? I suppose the answer lies in how the question itself is framed. I do not understand the various gender divides as competitions, or as assignations of unequal resources or restricted abilities. Nor, for that matter, do I see us as equals –of course there are physical differences, different aspirations, different Weltanschauungen- but so what? Everybody is different from everybody else. We are not clones. No one is actually ‘equal’.

I think that the time has come to forget about the ever-changing definitions of equality and rejoice in what makes each of us unique. What we need to espouse is fairness –in every interaction. All the rest is poor translation.

 

What is the Merit of Originality?

‘I am not young enough to know everything,’ as Oscar Wilde once said, and maybe the rest of us aren’t either. It is often an unquestioned assumption that New trumps Old, that innovation usually leads to improvement, and that by standing on the shoulders of giants, the view is necessarily better. Clearer.

But there is wisdom in both the long as well as the panoramic views. Neither changing  your shoes nor altering your hat, really improves the safety of a voyage -nor does it address the original goal of a safe arrival of everybody on board. Appearing modern, seeming prepared, only helps if it helps –a leak is still a leak, especially if there are only lifeboats for a few…

Let me explain. I happened upon an article in the journal Nature that chronicled the introduction of a new, and highly accurate method of diagnosing TB through genetic analysis.  https://www.nature.com/news/improved-diagnostics-fail-to-halt-the-rise-of-tuberculosis-1.23000?WT ‘The World Health Organization (WHO), promptly endorsed the test, called GeneXpert, and promoted its roll-out around the globe to replace a microscope-based test that missed half of all cases.’ It sounded like a perfect technological fix for a disease that has so far avoided effective control. ‘Some 10.4 million people were infected with TB last year, according to a WHO report published on 30 October [2016?]. More than half of the cases occurred in China, India, Indonesia, Pakistan and the Philippines. The infection, which causes coughing, weight loss and chest pain, often goes undiagnosed for months or years, spurring transmission.’

Unfortunately, ‘[…] the high hopes have since crashed as rates of tuberculosis rates have not fallen dramatically, and nations are now looking to address the problems that cause so many TB cases to be missed and the difficulties in treating those who are diagnosed. […] The tale is a familiar one in global health care: a solution that seems extraordinarily promising in the lab or clinical trials falters when deployed in the struggling health-care systems of developing and middle-income countries. “What GeneXpert has taught us in TB is that inserting one new tool into a system that isn’t working overall is not going to by itself be a game changer. We need more investment in health systems,” says Erica Lessem, deputy executive director at the Treatment Action Group, an activist organization in New York City.’

But I mean, just think about it for a minute. ‘The machines cost $17,000 each and require constant electricity and air-conditioning — infrastructure that is not widely available in the TB clinics of countries with a high incidence of the disease, requiring the machines to be placed in central facilities.’ Sure, various groups agreed to subsidize the tests in 2012, but: ‘each cost $16.86 (the price fell to $9.98), compared with a few dollars for a microscope TB test.’ So which test would you choose if you were a government strapped for cash to provide for healthcare for a broad spectrum of other equally pressing needs?

‘Even countries that fully embraced GeneXpert are not seeing the returns they had hoped for. After a countrywide roll-out begun in 2011, the test is available for all suspected TB cases in South Africa. But a randomized clinical trial conducted in 2015 during the roll-out found that people diagnosed using GeneXpert were just as likely to die from TB as those diagnosed at labs still using the microscope test.’ That seems counterintuitive to say the least.

So what might be happening? ‘Churchyard [a physician specializing in TB at the Aurum Institute in Johannesburg, South Africa] suspects that doctors have been giving people with TB-like symptoms drugs, even if their microscope test was negative or missing, and that this helps to explain why his team found no benefit from implementing the GeneXpert test. Others have speculated that, by being involved in a clinical trial, patients in both arms of the trial received better care than they would otherwise have done, obfuscating any differences between the groups.’

‘Even with accurate tests, cases are still being missed. Results from the GeneXpert tests take just as long to deliver as microscope tests, and many people never return to the clinic to get their results and drugs; those who begin antibiotics often do not complete the regimen.’ Clearly, technology alone, without an adequate infrastructure to support it –without a properly funded and administered health care system- is not sufficient.

And it’s simply not enough to have even a well-funded health system that benefits just those who can afford it, leaving the rest of the population to fend for itself, and only seeking help when they can no longer cope –often when it is too late. Health care is a right, not a privilege –no matter what those in power would have us believe.

I’m certainly not arguing that improving technology is not part of the solution, but sometimes I wonder if it is merely putting new clothes on a beggar. Handing out flowers in a slum.

Let’s face it, real Health Care is more than a sign on a door, more than a few people in white coats. It is a kind of national empathy. A recognition that even the poorest among us, have something valuable to contribute; that even those who have strayed from society’s chosen path, are who any of us might be, but in different clothes.

The myth of Baucis and Philemon tugs at my memory: They were an old married couple living in a small village in Anatolia (part of Asian Turkey nowadays) who, unlike everyone else in the town, welcomed two peasants at their door who were seeking refuge for the night. The couple, of course, were unaware that they were actually welcoming two gods, Zeus and Hermes, disguised as humans. A common enough trope, perhaps, but an instructive one, I think -one that transcends virtually all cultures, and borders: the idea of helping others without any expectation of reward. It is not an exchange -a transaction- so much as an action. Agape, in fact.

Health care is like that. Or should be… It’s not about the glittering display in the shop window –there to impress the passersby- it’s about the people in the shop.

 

 

 

 

 

 

 

 

 

 

 

 

 

The Feminist Egg

Once upon a time, I suppose that one of the characteristics of Age was its hubris. After a certain age, it was easy to dismiss most new things as mere variations on time-tested themes –additions, clever perhaps, intriguing even, but still accretions. Ecclesiastes lived in old minds: The thing that hath been, it is that which shall be; and that which is done is that which shall be done: and there is no new thing under the sun. And yet nowadays, even the quickest peek over the shoulder calls that into question. Maybe it always did, but without the publicity it now entertains.

New things –truly new things- are often the hardest to accept, especially if they fly in the  face of cherished beliefs sufficiently entrenched as to be regarded as not merely true, but obviously true -common sense, in fact. It took generations to accept evolution –and now it seems only sensible that the random acquisition of those traits that help survival will be the ones selected for in the next generation. It was not an upwardly purposeful spiral that inevitably led to homo sapiens; evolution doesn’t change cows to humans –it just eventually creates cows better able to survive in whatever milieu they find themselves. And randomly –the unfit are still granted existence, but if they are not suited, they pass on little benefit to their progeny.

It’s true that animals –mammals, especially- do attempt to influence desirable traits in their offspring by choosing healthy partners exhibiting those characteristics. Hence various mating rituals and dominance contests amongst the males; hence elaborate male bird plumage, presumably a proxy, recognizable by a receptive female, as indicative of a primus inter pares. And yet it was probably regarded as curious in premodern societies that a female would be accorded any important choice, let alone that of selecting what she wanted in a partner. Although there has always been a cadre of women who have made their marks throughout recorded history, the examples are sadly limited –curtailed no doubt, because it was usually men writing about what they felt was important to document.

Fortunately, times are changing, as is the realization that each side of the gender divide is equipotent. Just how fluid the roles are is a constant source of wonder to me. Even in these days of Darwin, I am amazed at the still unsuspected porosity of the envelope. And while it no longer seems unusual or unlikely that an information-processing organism like, say, a bird might be able to select an appropriately endowed mate based on observable clues, it is still surprising –to me, at least- that selection duties might be conferred on a more microscopic scale: on an egg, for example.

I first encountered this idea in an article from Quanta Magazine: https://www.quantamagazine.org/choosy-eggs-may-pick-sperm-for-their-genes-defying-mendels-law-20171115/  I have to say it reminded me of Hamlet’s rejoinder to the sceptical Horatio on seeing Hamlet’s father’s ghost: ‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.’

The competition in sexual selection was thought to be pre-copulatory –‘After mating, the female had made her choice, and the only competition was among the sperm swimming to the egg. This male-oriented view of female reproductive biology as largely acquiescent was pervasive, argued Emily Martin, an anthropologist at New York University, in a 1991 paper. “The egg is seen as large and passive. It does not move or journey but passively ‘is transported’…along the fallopian tube. In utter contrast, sperm are small, ‘streamlined’ and invariably active,” she wrote.

‘Beginning in the 1970s, however, the science began to undermine that stereotype. William Eberhard, now a behavioural ecologist at the Smithsonian Tropical Research Institute, documented all the ways that females can affect which males fertilize their eggs even after mating.’ For example, ‘Internal fertilizers have their own methods of what Eberhard dubbed “cryptic female choice.” Some female reproductive tracts are labyrinthine, complete with false starts and dead ends that can stymie all but the strongest sperm. Some females, including many species of reptiles, fish, birds and amphibians, that copulate with more than one male (which biologists estimate are a vast majority of species) can store sperm for months, even years, altering the storage environment to stack the odds to favor one male over another. Many female birds, including domestic chickens, can eject sperm after mating , which lets them bias fertilization in favor of the best male.’

The plot thickens. These strategies seem only to select whose sperm to allow access to the precious as-yet unfertilized eggs. But even sperm from the same individual can vary. So, are things just left to chance? Are we still talking Darwin here? And are the combination probabilities proposed by Mendel that depend on randomness still in the picture?

It would seem that the egg itself may have a say in which sperm it uses, and that unlike the voting system in many democracies, it may not be just the ‘first past the post’ -the marathon winner- who gets the prize.

The article presents several theories as to how the egg may be able to ‘choose’, but as yet there seems to be no clear indication as to whether it always happens, or whether it is just able to weed out some potentially damaging or clearly unsuitable ones by the signals they emit –or fail to emit… Sometimes, anyway. Mistakes clearly occur; abnormal genes do manage to slip through, leading to abnormal embryos –some of which are unable to develop enough to survive.

But that there may be yet another layer of protection built into the system –another unsuspected surveillance system- is what intrigues me. And that, once again, it seems to invest the power of a truly critical decision with the female is a cautionary tale for those who cling to the shredding coattails of androcentrism. It is simply another piece of evidence, if more were needed, that Life and all that it enables, is not a zero sum game. It is not a contest between genders, but a journey together. Still…

Let there be spaces in your togetherness.                                                                                      And let the winds of heaven dance between you.
Love one another, but make not a bond of love.
Let it rather be a moving sea between the shores of your souls.
Fill each other’s cup but drink not from one cup.
Give one another of your bread but eat not from the same loaf.
Sing and dance together and be joyous, but each one of you be
alone – even as the strings of a lute are alone though the quiver
with the same music.
Give your hearts, but not in each other’s keeping.
For only the hand of Life can contain your hearts.
And stand together yet not too near together:
For the pillars of the temple stand apart,
And the oak tree and the Cyprus grow not in each other’s shadows. –Kahlil Gibran –

I couldn’t resist.

 

 

 

 

 

Noceboes? How Cute.

I have always been fascinated by neologisms –new words that substitute for more commonly used ones. They can be clever, rude, or just plain silly, but often their point is to get noticed –or perhaps draw attention to their inventors. There was a time –before social media, at least- when we used to applaud people like Shakespeare for turning nouns into verbs, or adjectives into more active participants. And it was a time when elders, if they forgot the word for which they were searching, would simply come up with a new one. Of course, they still do, but it is often  lost in the ebb and flow of media utterage (pardon the neologism). I have written about this before in another context, but the subject continues to intrigue me: https://musingsonretirementblog.com/2016/05/22/what-did-you-say/

This time, however, I was more interested in the clever contrast of nocebo with the word it was replacing, placebo, that was reported in an article in the CBC health news: http://www.cbc.ca/news/health/nocebo-effect-greater-expensive-drugs-1.4358664

I suspect we’re all acquainted with the placebo effect: the ability of a harmless, inactive substitute to have a beneficial effect if it is believed to be the treatment. Again, I have covered this in a previous essay: https://musingsonwomenshealth.com/2016/04/20/rethinking-placebos/

But there seems to be no end to our ability to fool ourselves, and the concept of ‘noceboes’ is yet another illustration. ‘The opposite of the placebo effect — perceived improvement when no active medicine is given — nocebo is the perception of negative side-effects from a benign “medication” in a blind trial.’

The article reports on a study published in the journal Science, which suggests that ‘Expensive medicines can seem to create worse side-effects than cheaper alternatives.’ This particular investigation ‘focused on the pain perceptions of patients who were treated with creams they believed had anti-itch properties but actually contained no active ingredients.’ And, as one could no doubt predict from the title of their publication, Nocebo effects can make you feel pain, ‘Though the scientists ensured the temperatures applied to the two creams were consistent, those who received the expensive cream rated their pain as nearly twice as intense as those who received the cheaper cream. The study suggested that patient expectations related to price can trigger brain responses resulting in higher perception of pain, said Alexandra Tinnermann, a co-author of the study and neuroscientist at University Medical Center Hamburg-Eppendorf.

‘Tinnermann’s team used a functional MRI scanner to identify areas along the spinal cord that were activated during participants’ experience of side-effects. They also pinpointed two brain regions that were more stimulated among participants who believed they received the expensive drug.’

The ethics of using placebos –tricks- is one thing, but what about those of choosing between several recognized and approved medications where the only difference is the price? On the surface, it might seem to be a saving for all concerned. If the data hold up in further studies, why prescribe new and probably higher cost medications, if they’re more likely to have side effects?

Unfortunately the very ethics that require medical practitioners to discuss the possible side effects of any medication, are also known to influence the experience. Knowledgeable patients report more side effects than those who, for whatever reasons, are blissfully unaware of what to expect. Perhaps it’s more a question of which of Pandora’s boxes the practitioner should open -a zero sum game, no matter.

I was sitting on a park bench in the shade of a tree one sunny summer day, trying to finish a book a friend had loaned to me. It wasn’t very interesting, despite her recommendations, and although I was determined to discover what she had liked about it, I found my mind looking for excuses to put it down. My ears soon found a distraction. Two little boys had abandoned their bikes on the  grass nearby and were engaging themselves in scaling the leafy tower of what I had assumed was my own special shade tree. Hidden by several bouquets of leaves fluttering gently in the afternoon breeze, I suppose they thought they were invisible in their private redoubt.

“Thought you were sick, Jay,” one of them said, as if he wondered if he was in danger of catching whatever Jay had.

“I’m on antibiotics, Jordan,” the other answered defensively.

They were silent for a few moments, although I could hear them grunting as they climbed ever higher.

“My mother doesn’t believe in them,” a voice, probably Jordan’s, said very firmly.

“Why?” was Jay’s surprised reply.

Jordan was silent for a moment, clearly trying to remember. “She says they can make you sick.” Even from my position far beneath them, I could almost feel Jordan’s italics.

“How?”

Another, grunt-filled silence as they switched branches. “She says they can make your skin go red…” He hesitated for a minute while he combed through his memory. “And give you… make you wanna throw up.”

Jay seemed to hesitate before answering. “Well, I’m not red or anything, but… uhmm, sometimes I do feel a little like throwing up, I guess. Anyway I have to go to the toilet a lot, so it’s hard to tell.”

“She says that’s what happens with them too, Jay. It’s why I just take vitamin pills.”

“My mother says those don’t usually work… People only think they do.” Jay felt a need to defend his antibiotics. “Mom says we imagine things sometimes…”

“Like what?” Jordan sounded sceptical. For a while, I could only hear the leaves rustling, so I wasn’t sure if they’d already climbed too high to hear.

“Like… Like that vitamins can keep us from getting sick.” I could hear one of them shifting somewhere above as a branch cracked. “And she says some people won’t take antibiotics because they’re afraid of, uhmm…” He hesitated, while he searched for the right word. “…the side-stuff.”

“You mean ‘side-defects’?” Jordan pronounced the words carefully, condescension fairly dripping from his words.

“Yeah. She says if they hear about the defects, they figure they’ll get them.”

“Well my mom says doctors have to tell people about them, though, Jay… It’s the law.” He added smugly.

Jay seemed to think about it for a second. “Then no wonder, eh?” he said, as if he finally understood.

“No wonder what?”

“No wonder people get ‘em,” Jay answered, triumphantly.

From the mouths of babes.

Does the Best Safety Really Lie in Fear?

There are many unheralded benefits of age, one of which is invisibility -changing from a potential threat into a banality. A non-entity for whomever might otherwise be at risk. I can watch from shadows while the world strides past –on the street, in a bus, in a coffee shop. Wherever.

Men, until they age it seems, can be a liability to women –but I never thought of it like that, of course. Few of us ever do. I never thought I was a threat, but now I see I was wrong.

Does danger evolve, or is it the perception? The perceiver? Has its essence been reinterpreted, or merely renamed? Now that I am rapidly becoming a befrailed bystander in my retirement -background noise- I am also subject to harassment I never thought existed.

It’s not the same, I know. It’s not something I have had to endure throughout my life. Something woven into the fabric of each day that hides in the warp and weft of life until the pattern suddenly surfaces from the chiaroscuro like the shark’s fin in Jaws. Knowing the menace is always somewhere beneath the surface, and yet having no choice but to swim above it…

Watching from the shore, where the danger is rarely seen and never felt, it is all too easily dismissed. Maybe that’s why I’m trying to draw a parallel with the tide of years. I’m trying to understand something new to me. Frailty, thy name is Age.

For me, it’s not sexual pestering, of course, and usually not a threat of bodily harm –it’s more of a dominance thing… And yet, isn’t that what the gender divide can be about? Power? Identity insecurity? Role playing…?

I’m not even sure what role hormones play anymore –not all men are provocateurs. Not all men are cursed with the need for entitlement or the fear of losing status . Not all of us are insecure. But I think I can see what is going on –if only through a glass darkly. I think I can understand the gist of the article I found in the BBC news about women worrying about the ‘right’ amount of fear to show in public: http://www.bbc.com/news/world-41614720 The appropriate balance between sensible caution and the avoidance of a perceived threat.

Until I read it, I’m not sure I would have put it as forcefully as Dr. Fiona Vera-Gray, a researcher at Durham Law School, specializing in violence against women, and one of the 100 Women BBC named as influential and inspirational. But, I’m not a woman quietly smothered by the social blanket either thrown over my protests, or wrapped securely around my screams of dissent much as it might around a tired child’s body. It is hard to shift perspective like the article demands.

Dr. Vera-Gray had been speaking to women about how they change their behaviours through fear of sexual harassment and assault for her new book The Right Amount of Panic: How women trade freedom for safety in public. But I have to say that I had never thought about the need for the tactics she has identified that are outlined in the article. 

For example, she outlines conduct I’m sure we’ve all seen in streets and public transit –all seemingly innocuous, innocent, and yet all purposive: ‘Maybe, like Delilah, a black British woman in her early 20s who I interviewed, you stay away from wearing the colour red, to avoid standing out. Or like Shelley, a British Asian woman in her 30s, you’ve developed a death stare, looking tougher than you feel. Maybe like Lucy, a white British woman in her late teens, you’ve pulled out your phone and made a fake call with your battery long dead. Or like Ginger, a white Latvian woman in her 20s, you’ve kept headphones in without playing music so you can hear what they think you can’t.’

The European Union Agency for Fundamental Rights report (FRA) in 2017 on sexual harassment in Europe found that ‘almost half of the 42,000 women surveyed had restricted their freedom of movement based on the fear of gender-based violence.’

‘Liz Kelly, one of the world’s leading sociologists on violence against women, coined the term “safety work”, to describe the habitual strategies that women develop in response to their experiences in public. We perform safety work often without thinking, it becomes part of our habits, or “common-sense”.’ Peeking over my own male-built walls, I had no idea this was going on.

‘The vast majority of this work is pre-emptive, we often can’t even know if what we are experiencing as intrusive is intrusive unless it starts to escalate: he speeds up and crosses the street when you do, he moves from staring to touching. But as this is the very thing safety work is designed to disrupt, success becomes the absence of what might have happened. […] we know that it doesn’t, it simply can’t, always work, and those are the only times we can count. So women are stuck, made responsible for preventing harassment at the same time as unable to know when we’ve been effective.’

But, as Dr. Vera-Gray seems to conclude, ‘[…] there is no “right amount” of panic, there’s only ever too much or not enough. And with no way to know when we’re getting it right, we’ve learnt to just keep quiet.’

I don’t want to seem like a gender apostate, but I find the conclusions very troubling. As Robbie Burns put it O wad some Power the giftie gie us To see oursels as ithers see us! But, alas, we see the world, like we see the reflections in a mirror, only through our own eyes. And that’s not enough –we share the same journey, albeit sometimes on different paths. And that’s why there’s a need for signposts along the way. Conversations about the route. We all have to know where we’re going.

Maybe I will never understand; maybe I can only approach it vicariously, but at least it’s a start. I can stand in shoes that will never fit, even if I can’t walk without discomfort.

But maybe that’s what it takes –a sort of self-empathy, before it finally sinks in…

Is What’s Past Really Prologue?

War has so many faces and wears so many different clothes that you might be forgiven for misunderstanding its refugees. Confusing cause and effect in their behaviour, their appearance, and perhaps, most obviously, in their adaptations to the stress of upheaval and migration. There is no universal pattern that obtains, and few things to offer as a template for relief except, perhaps, a welcoming succour. And when numbers become overwhelming, even compassion is strained in the melange of personalities and temperaments that inevitably occur in those fleeing danger. Not all victims may be to our liking, and when resources become limited and privileges are necessarily constrained, the reactions can be unpredictable on both sides. Empathy can mutate into grudging tolerance. Forbearance. Endurance.

But think of the effects on the refugees, first forced to flee intolerable conditions, often leaving behind members of their families, then subject to the hardships and exploitation of the journey,  finally being forced to trust themselves to the charity of strangers. It cannot be easy for adults to have their identity subsumed by that of victim, and everything they were, everything they had, everything for which they had worked no longer possible. No longer recognized, let alone appreciated, in a strange land with often stranger customs and language.

And what must it be like for their children who haven’t yet learned the curse of humiliation, or understood what the theft of identity may mean to their parents. They’re caught in the middle ground between witness and casualty, understanding neither. Lacking the tools to navigate the waters, some, I suppose, internalize it; others lash out. But none escape entirely.

I came across an unusual manifestation of trauma that seems unique to Sweden (so far), for some reason –the newly coined Resignation Syndrome: http://www.bbc.com/news/magazine-41748485  ‘[…] it affects only the children of asylum-seekers, who withdraw completely, ceasing to walk or talk, or open their eyes.’

‘The health professionals who treat these children agree that trauma is what has caused them to withdraw from the world. The children who are most vulnerable are those who have witnessed extreme violence – often against their parents – or whose families have fled a deeply insecure environment.’

‘As more Swedes began to worry about the consequences of immigration, these “apathetic children”, as they were known, became a huge political issue. There were reports the children were faking it, and that parents were poisoning their offspring to secure residence. None of those stories were proven.’ A not so hidden ‘blame the victim’ scenario that tends to surface under conditions of societal stress.

‘Numerous conditions resembling Resignation Syndrome have been reported before – among Nazi concentration camp inmates, for example. In the UK, a similar condition – Pervasive Refusal Syndrome – was identified in children in the early 1990s, but there have been only a tiny handful of cases, and none of them among asylum seekers. The most plausible explanation is that there are some sort of socio-cultural factors that are necessary in order for this condition to develop. A certain way of reacting or responding to traumatic events seems to be legitimised in a certain context’ writes Dr Karl Sallin, a paediatrician at the Astrid Lindgren Children’s Hospital, part of Karolinska University Hospital in Stockholm.

Theories abound, of course. There is a view ‘commonly held among doctors treating children with Resignation Syndrome, that recovery depends on them feeling secure and that it is a permanent residence permit that kick-starts that process.’ Unfortunately, with increasing numbers of refugees arriving, both the patience and the available resources are wearing thin, so stricter adherence to admission criteria do not always allow a family to stay. ‘Last year, a new temporary law came into force that limits all asylum seekers’ chances of being granted permanent residence. Applicants are granted either a three-year or 13-month visa.’

One treatment seems to be having some success, even with those not granted permanent visas, however. The thesis is that  sickness has to do with former trauma, not asylum. ‘When children witness violence or threats against a parent, their most significant connection in the world is ripped apart’ –the very connection on which the child has been dependent. ‘That family connection must be re-built, but first the child must begin to recover, so Solsidan’s [the treatment center’s] first step is to separate the children from their parents. “We keep the family informed about their progress, but we don’t let them talk because the child must depend on our staff. Once we have separated the child, it takes only a few days, until we see the first signs that, yes, she’s still there…” says Annica Carlshamre, a senior social worker for Gryning Health, a company that runs Solsidan, a home for all kinds of troubled children.

Even if effective, I would imagine that not every family would be willing to part with their child to strangers, nor would the number of treatment centers be equal to the task. Still, it may be a method worth exploring further.

Post-Traumatic Stress Disorder, Resignation Syndrome, Situational Adjustment Reactions, Panic Attacks… I am not alone in wondering what these may produce in the hundreds of thousands, if not millions, affected –either in childhood when coping mechanisms may not yet have been learned, or worse perhaps, in adulthood when the mechanisms may have been discarded. What can we expect from a generation torn from its customs, and rightful expectations of a peaceful family life? A generation often deprived of education, to say nothing of safety? What is normal to those who have never experienced it? And what are the obligations of the rest of us to them?

War, it is said, will be with us always, but we must not be fooled by its seeming inevitability. I suppose it is unbecomingly naïve in this time of terrorism and bellicose patriotism, but I still remember the words of Martin Luther King, Jr: “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”

An ounce of prevention is worth a pound of cure? It’s not an answer, perhaps -just a hope…