Is there really nothing new under the sun?

What has been will be again, what has been done will be done again; there is nothing new under the sun. The older I get, the more I understand the wisdom of that passage from Ecclesiastes. It’s not that I have experienced everything, seen everything, and I certainly haven’t thought of everything; I have no proof whereof I speak, and yet… And yet it seems to wear the ring of understanding, doesn’t it? ‘It is the province of knowledge to speak and it is the privilege of wisdom to listen’ as Oliver Wendell Holmes once said.

I suspect there’s something truly atavistic about touch. Something inescapable, at any rate. Birth, suckling, and rearing are universals –at least for mammals- and each involves contact, albeit a closeness that often diminishes with a maturity that adopts different forms of communication. Different types of connection. But its primacy never really disappears –whether in fighting, copulating, or even greeting, it lingers like a shadow never fully in the background.

I’ve written about it before, sometimes vicariously, with a soft brush, sometimes even with a gentle nudge, and once when I was moved sufficiently to address it as a subject worthy of a title: Touch  https://musingsonwomenshealth.com/2013/01/25/touch/ But somehow, it creeps back again and again as needful as a hungry child to be noticed.

Like the fabled Phoenix, it rose anew in an article in the CBC news, and as a still-unrequited lover, I have rushed to it again with open arms: http://www.cbc.ca/1.4363121 It’s amazing how such a basic thing as touch seems to require mention again and again – as if without the attention it would slip beneath the waves like a curious seal and be seen no more. As if we continually need the reminder to see our noses.

And each time it surfaces in a different place than we expect. ‘In the past 20 years, scientists have discovered that our hairy skin has cells that respond to a stroking touch. It’s a trait we share with other mammals. Now psychologists in England say their work shows, for the first time, that a gentle touch can be a buffer against social rejection, too. […] The study builds on previous ones showing that receiving touch from loved ones after a physical injury is supportive.’ -a coals-to-Newcastle study you may ask? I mean, really… But I suppose that statistical validation is a way of indicating that it is a conclusion once-removed – that the findings are hopefully divorced from any possibility of emotional contagion. Still…

It continues, ‘Pain is ubiquitous across medical disciplines. Yet touch has been shown to improve outcomes in people with rheumatoid arthritis or fibromyalgia and in pre-term infants, the study’s authors said.’ Once again, the older and wiser amongst you might have to fight against the urge to roll your eyes. Of course touch is important, I hear you whisper, as you move on to another, less flagrantly transparent article.

There was a point to underlining the glaring intuitively common sense observations, however –but not, alas, until the nether end of the article. ‘Our brains are attuned to combining information from our five senses. And when much of our time is spent engaging with social media, which relies on visual and sound cues alone, it’s easy to forget the power of touch.’ This, in an era of proxy reaching, and touching a friend online -‘just “liking” a post or texting an emoji.’

Maybe it’s more obvious to those of us who didn’t grow up with a smartphone in our hands or a screen in our face, but it still needs repeating: Of course touch is important! So is actual eye contact. And body language. There’s something about proximity that facilitates communication and realistic interpretation.

A study at St. Francis Xavier University in Nova Scotia –one of undoubtedly many of this type- tracked ‘100 mothers and babies over four years [and] they found mothers who used skin-to-skin contact reported breastfeeding for a longer period, less postpartum depression, and a closer relationship with their babies compared with mothers who did not use the method.’ Without re-stating the obvious, the contention was that ‘Because the baby is being held so close to the mother, the mother learns the baby’s signals…’ And, of course, then the usual self-evident trope that ‘It’s not just newborns who benefit from skin-to-skin cuddling — moms do, too’ with the requisite reductionist explanation ‘For the mother, the close contact stimulates the hormone oxytocin, which helps to promote maternal feelings’ as if a physiological justification for the observation were required to bolster the issue… Just in case.

Surely we know all this, though. Surely, if we look around us we can see touch in action -even in a downtown shopping mall.

I rarely go to malls -I find the crowds of strangers annoying- but every so often, the anthill instinct surfaces, and I dip my foot in the colony just for the experience.

I am usually wary of casual contact and, as on a busy sidewalk in the city, there is an unconscious dance to avoid touching strangers. It’s not a fear thing, nor a dread of pestilence; I do not feel uneasy for myself or my property, so much as that my closeness, however accidental and unintended, might be misconstrued. Touch can be therapeutic and welcomed, for sure, but it can also be unwarranted -misunderstood by a stranger – frightening or threatening if unrequested.

I picked the wrong time to test the mall, I think. It was noon and filled with casual shoppers, their eyes on window displays, and bags akimbo, they wandered aimlessly from store to store, depending on a mall-acquired skill to avoid the Brownian motion alive around them. Me? I felt more dizzy from the chaos than innately protected, and found myself leaning rather self-consciously on a pillar near a bank of seats, watching for a vacancy to rest. I admit I shouldn’t have let down my guard, but I am basically a visiting country mouse -a mall virgin, I’m afraid.

Still, I didn’t expect to be knocked down by a distracted shopper –a thin, middle aged woman at that- but I suppose that anybody, if hit unawares, would go down as quickly. At least that was my embarrassed conceit on my way to the floor.

The woman, a business executive by the look of her dark-blue pant suit and blindingly white blouse, was mortified and stooped to help me up. I must have looked confused –I’m sure I was- at the sudden horizontality of my position when she first extended her hands to me.

“Are you alright, sir?” she said, her eyes leaning heavily on my face. “I’m so sorry… I don’t know how I managed that…” she added, her words thick with remorse.

Sometimes, I think I look younger than my years –one gets used to the reflection in the mirror- but obviously she saw me in a different, more fraught light, and her expression melted as she mistook my surprise for fragility. Suddenly she hugged me –a brief, but reflexive attempt at apology. It couldn’t have lasted more than a fraction of a second, but it was as if, for that instant, she was not a stranger, but a caring person responding to the needs of another.

She blushed at my smile, then touched my sleeve as she walked away, her head disappearing in the crowd like a bird in a forest. But I have not forgotten that heartfelt touch. Some things are special –ordinary or not. Touch is a gift, and I felt unexpectedly blessed…

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Whether ’tis Nobler in the Mind

I may have inadvertently stumbled upon something important. I may have found a boundary marker that potentially distinguishes New Age from Old Age. Of course, definitionally I could be way out of my league –New Age being construed as anything that happened after I left university- but considered as a panoply, I think it works, if only conceptually.

I happened upon an article in the CBC news app while scrolling through my phone, that struck me as interesting: http://www.cbc.ca/1.4302866 -perhaps because I had never thought about technology in those terms, and perhaps because I felt embarrassed that I had been caught doing just that.

The premise was that we seem to turn to various apps on our devices for problem solving of many sorts. Everything from comparing shopping prices to trends in fashion to the latest news. And, as we are increasingly discovering, these digital peregrinations revisit us in the form of directed advertisements hoping to cash in on our whimsical journeys. Nothing is thrown away in the digital world –even our whims are stored, categorized, and pragmatically redistributed. And if notions, then it seems a small step to include moods. Emotions –positive, or otherwise- should be equally trackable.

In fact, I learned that ‘Google announced it now offers mental-health screenings when users in the U.S. search for “depression” or “clinical depression” on their smartphones. Depending on what you type, the search engine will actually offer you a test. […] And Facebook is working on an artificial intelligence that could help detect people who are posting or talking about suicide or self-harm.’

Perhaps this is where I feel the shadow of a boundary issue. There seems little question that mood disorders transcend age and gender; what is more problematic, however, is whether there may be a generational divide in confiding those emotions digitally, or even believing that solace could lie therein. The problem is not so much in putting these issues in writing –diaries, and correspondence, after all, have long been a rich retrospective source for biographers. The difference, it seems to me though, is the intent of the disclosure –diaries have traditionally been personal, and usually, not meant as a way of communication, but rather a way of sorting out thoughts. Private thoughts. Letters, as well, were directed to particular individuals –often trusted confidants- and not meant for publication outside that circle. Have the older generation –Generation R, for example (Retirement, to attach a label)- been sufficiently swept up in the digital river, to feel comfortable in clinging to its flotsam like their children?

I’m certainly not gainsaying the efforts of the internet giants to expand into the mental health realm –it seems a natural progression, so perhaps this is a start… and yet it’s one thing to key in on various words like ‘depression’ and have the algorithm kick in with a screening test, but another to sift through the context to determine the appropriateness of offering the test. I suppose random screening like that may be helpful for some, but as Dr. John Torous, the co-director of the digital psychiatry program at Harvard Medical School and chair of the American Psychiatric Association’s workgroup on smartphone apps, observes, ‘”One of the trickiest things is that language is complex … and there’s a lot of different ways that people can phrase that they’re in distress or need help.”’ Amen to that.

Quite apart from translational difficulties and the more abstract and culturally-fraught issues with their changing metaphors and societal expectations, there are other language problems –even in the dominant language of whatever country: changing vocabularies, local argot, and misspellings, to name only a few.

To state that human culture is complex, is a trope, and to believe that artificial intelligence will be able to keep up with its multifaceted, ever-changing face, anytime soon is probably naïve. And, as the article points out, privacy –no matter the promises of the internet provider, or the app-producer- is another weak link in the chain. Quite apart from malicious hacking, or innocent and trusting confidence in the potential for help, ‘Our phones already collect a tremendous amount of personal data. They know where we are and who we’re speaking and texting with, as well as our voice, passwords, and internet browsing activities. “If on top of that, we’re using mental-health services through the phone, we may actually be giving up a lot more data than people realize,” Torous says. He also cautions that many of the mental-health services currently available in app stores aren’t protected under federal privacy laws [at least in the United States], so you’re not afforded the same privacy protections as when you talk to a doctor.’

In a very real –if mainly age-related- sense, I am relieved I did not grow up in the digital age. I am fortunate that Orwell’s prescient ‘1984’ was available, not as a quaint attempt at predicting the future, but as a warning about a creeping surveillance that seemed so malevolently unrealistic when it was written –it was first published in 1949, remember. And when I read it, the date was still sufficiently far in the future that it seemed more science fiction than predictive. Yet, as the years wore on, and society changed in unexpected ways, the horrors of the theme, for me at least, became more and more uncomfortable. More and more possible, despite the reassuring smoke blown in our eyes by those eager for progress, and mesmerized by the possibilities.

I mention this, not to suggest that I was unique in this discomfort –I was obviously not- nor to imply that what we are now experiencing is evil, or even threatening, but merely to explain the hesitation of many of those my age in accepting, unreservedly, the digitally-wrapped gifts so readily proffered. It is not a venue to which I would likely turn for health issues, or emotional sustenance.

For me, there is something more reassuring about an eye-to-eye encounter with another member of the same species, able to understand the vagaries of language, and compare the nuanced phrasing of my words with the expression on my face. Perhaps, I’ll change -perhaps I’ll have to- and yet… and yet I’d still feel better dealing with an entity –a person– able to experience the heart-ache and the thousand natural shocks that flesh is heir to. And yes, someone who has read and understood what Shakespeare meant.

Remembering Forgetting

We have to be careful, don’t we? Sometimes, we have to force ourselves to step back for a moment. When we want something –need something- to reassure us that we will be okay despite signs to the contrary, it’s all too easy to believe. All too easy to slip back into the warm, reassuring arms of a parent who tells us what we want so desperately to hear: that everything will turn out all right…

And I suppose that each of us has her favourite skeleton. However farfetched it may seem to others, it is a source of undue angst whenever the subject is broached, albeit innocently. With my mother, it was her curls. She lived in the sure and certain knowledge that when she got old, her hair would turn as straight as hay. It didn’t, but then again, I was never privy to whether or not her hairdresser was an accomplice.

My father, on the other hand, worried about God –but only, it has to be revealed, after I began to bring home my university textbooks on Philosophy to try their arguments out on him. At the time, I think I felt I was sharing my newfound freedom of ideas, but in retrospect I realize it was unkind.  His background religious beliefs had not prepared him for the convincing effectiveness of rhetoric in destroying what clever minds had decided were untenable arguments. He had not learned to step back; he had not learned to consider the source. Nor had I, for that matter…

It is why I have to be careful. It is one thing to cherish words and venerate ideas, and another to be convinced by those which foster only those with which I have formed an allegiance. Perhaps that’s unfair not only to me, but to the ideas, and yet there is something distinctly unsettling about pernicious change. It’s why, throwing critical thinking to one side on occasion, I revel in reassurance. I want to believe in good-news experiments that cradle me, however briefly, in their arms.

There was a brief summary in a CBC News Second Opinion section with the title ‘Remembering forgetting could be a good thing.’ Now, how could that not attract the attention of someone whose bête noir is just that? Someone who chafes at the declining powers of a once proud memory? Someone who wants to blame it on age, and yet dares not –and whose mind, scrabbling among shards of memory, is persistently reassured that it can still remember the lament of Macbeth before his battle with Macduff at Dunsinane: ‘My way of life is fall’n into the sere, the yellow leaf, and that which should accompany old age, as honor, love, obedience, troops of friends, I must not look to have, but, in their stead, curses, not loud but deep, mouth-honor, breath which the poor heart would fain deny and dare not.’ Some things burrow deeply into the unguarded psyche, however irrelevant.

But the article, reporting on a study published by Dr. Philip Gerretsen (a clinician scientist at Toronto’s Centre for Addiction and Mental Health) in the Journal of Clinical Psychiatry: http://www.psychiatrist.com/JCP/article/Pages/2017/v78n08/16m11367.aspx said that ‘Using brain imaging data and other clinical information from more than 1,000 patients with early cognitive decline, his new study suggests there’s a relationship between a person’s level of awareness of memory issues, and their risk of future disease.’ I cling desperately to fragments like this. ‘”Most intriguingly it’s the patients that seem to be hyper-aware of having some cognitive problems relative to their caregivers that actually don’t go on to develop dementia,” Gerretsen said, adding that those people might be suffering memory loss for other reasons, including anxiety or depression.’

And not only do I derive some satisfaction from his findings, I’ve also learned a new word that I hope to sprinkle surreptitiously into a conversation if I can actually remember it long enough: anosognosia — a neurological term for not knowing that you’re sick. Not realizing, in other words, that you’re forgetting things. ‘Gerretsen says there’s a suggestion that Alzheimer’s disease might be affecting the brain regions involved in illness awareness.’ I’ve decided that’s what I now think, too. It’s another straw to grasp, I suppose.

And yet, true to its etymology, the concept of anosognosia is not very well known. I was in a hospital elevator one afternoon on my way to the subterranean parking lot after visiting a friend. Normally crowded, there were only two older, but tired-looking nurses huddled in the corner of the little chamber leaning heavily on the walls, and one was shaking her head slowly. “I get so annoyed with myself, Fran,” she continued, hardly noticing the novelty of my presence.

Fran, a stout woman with short, messy hair, managed to raise her eyes enough to rest them on her friend’s face. “Why’s that, Judy?” She didn’t really sound that engaged in the conversation –just polite.

Judy, equally stout, but perhaps because of her bright red dress, looking the more refreshed of the two, sighed. “I always forget where I parked the car.”

The thought seemed to perk Fran up a little. “Happens to me all the time… I guess we park here so often, one space seems just like any other.”

“Yeah, but I really tried this morning… I did something or saw something I was sure would help me remember…”

Fran chuckled, more fully awake at the thought. “And now you can’t remember?”

Judy shook her head, smiling. “Worrisome, eh?”

They were both silent for a moment, and then Judy rescued her body from the wall in preparation for leaving, and glanced at her friend. “Do you think remembering that I’m forgetting things is a good sign…?”

Fran thought about it for a moment. “I would think that forgetting that you’re forgetting things would be worse…” she said as the elevator door opened and the two of them got out, giggling like schoolgirls.

Maybe some things are intuitive. Maybe hope is one of those things.

The Feast of Fools

It’s hard to switch sides, isn’t it? Hard to cross the tracks. And even if you do, does welcome await, or merely sidelong glances and mistrust -or as Macbeth feared, curses not loud but deep, mouth honour, breath which the poor heart would fain deny and dare not…?

It’s a brave person who crosses over –who dares to live the other life. But can one ever feel what one has only watched from afar? Would the experience be real, or only a tawdry simulacrum? A Halloween costume? True, only we know for sure how we perceive something, but we can intuit how someone else might feel –and realize that they might also have a different understanding of what happened. A different reality. So, are we unalterably barred from that room?

I ask this as a man peering over the fence and wondering about what I see. It always seems so… so like my side –so like the cover of the book I’m reading. I suppose that’s where it gets confusing. I know the story is different, and yet I don’t really understand why. But then again, perhaps I’m as naïve a reader as I am a contributor –or is that merely a pretence of innocence? An expected social conceit?

And if I were to attempt a disguise in a situation that even I could see might be demeaning for a woman, would that help me understand? Or would it merely seem weird, and elicit the confused and embarrassed reactions that cross-dressing usually does? Would it take me closer to the lived experience? Or would it be yet another variation of the male Weltanschauung?

An article in the CBC news on sexual discrimination in the workplace made me wonder: http://www.cbc.ca/news/canada/ottawa/workplace-sexual-discrimination-men-heels-union-613-1.3483305 ‘The male staff decided to dress up after a CBC Marketplace story  […] on restaurant dress codes and found that many women felt compelled to wear sexy outfits —including high heels, tight skirts and heavy makeup — to keep their jobs.’

I have to say that at first glance, I was reminded of the Medieval Feast of Fools. This, as you may recall, was a festival usually held at the beginning of the new year (especially in France) in which a mock bishop or pope was elected, ecclesiastical ritual was parodied, and low and high officials changed places. And, according to the Encyclopedia Britannica, by the 13th century these feasts had become a burlesque of Christian morality and worship. But nobody was fooled; everybody realized it was just a charade…

In the case of the restaurant, ‘The men lasted only an hour or two in the heels, which ran the gamut from red stilettos to cheap, black, strappy numbers. But aside from the physical pain, they also described feeling vulnerable and uncomfortable as they worked.’ And understandably so –they were pretending to be something they most decidedly were not. Everybody –customers and staff- knew it and no doubt played along. ‘”Guys were making comments, jokingly of course, because that’s what we were going for — to show light to it — but even those jokes that they were making were, after a while, still very uncomfortable to be faced with,”’ said one of the servers.

A few of the customers were women who also worked as servers at other restaurants with similar dress codes where they were told to look like they were going to a party, not coming home from it. One of them, who had recently quit one of those places after being sent home for not wearing enough jewellery on her shift, said: ‘”I came here tonight because I love the idea of reversing sexist dress codes required in some restaurants to male colleagues. Seeing them wearing heels and short skirts is really something. I wanted to come down and be a part of it,” she said.

‘”It reinforces how ridiculous it is. Seeing men walk by in tight miniskirts and heels really just hits it home how crazy it is to ask women to do that.”’

The consensus among the women servers watching was that within limits, dress should be about choice. If they felt comfortable with dressing like what they were seeing, that was fine. But many of them didn’t. The doctrine of contra proferentem might apply, perhaps, but I doubt that many of them would go so far as to hire a lawyer to press their cases.

So, apart from some interesting publicity and a bit of teasing, what did the cross-dressing actually accomplish? For guys, dressing like women and trying to balance on high heels they’d never been acculturated to wear -and never had the opportunity to practice on- can only give them the barest whiff of what many women have to endure on an ongoing basis. They weren’t women that night, just actors rehearsing a drama they would never get to play.

Clearly, what the article was pointing out was the tip of a very large iceberg. Highlighting this form of sexual exploitation was merely a way of hinting at the way women in general are regarded in our society –and maybe not just ours… You can legislate fair hiring practices, but it is far more difficult –impossible, actually- to legislate attitude.

It is true, however, that unless the issue is publicized in a manner that shocks people into seeing it, there is unlikely to be any change. Some are hoping the protest might go national, with similar events taking place in various cities across the country. But I worry that, although the cause is worthwhile, too frequent repetition of the burlesque, is also a way of making it seem just confrontational -turning a good idea into a parody, and losing the point it was originally intended to make.

As long as shareholders and owners of companies see profit in sexualizing young women –and men, for that matter- the battle for change will be an uphill one. We are already seeing a backlash against ‘political correctness’, to the extent that many of the gains made in the past few decades are being sidetracked, or even eroded. I suppose it was inevitable that direct confrontation with the status quo would be resisted as would any threat.

But the solution, it seems to me, lies not in confrontation, but in changing what we accept as normal –as proper. And it is already being done with some success nowadays through both social media and advertising strategies. Just look at the change in attitudes about, say, smoking in restaurants, or driving home after a night at the pub. There are already recent, albeit tentative steps in various TV and internet-streamed programs –sitcoms and the like- to portray women less as sexual objects, and more as equal partners in their dealings with men. Some episodes have even attempted, as did those male servers in that Ottawa restaurant, to depict the humiliation that men would experience were the roles reversed. And people are watching and getting used to the idea because the characters on the screen are making it seem, well, normal. Accepted, not contentious. And certainly not antagonistic.

Nothing happens overnight, of course, and although we are understandably impatient for more progress, change that is too rapid often leads to rebellion -especially if that change is precipitate. Unexpected -or worse, abnormal!

“How poor are they that have not patience!” says Iago in Shakespeare’s Othello. “What wound did ever heal but by degrees?”

Crybabying

I remember (sort of) my days in Elementary School, when one of the most devastating insults a little boy could receive was to be labelled a crybaby. I’m not sure why, really. Maybe it meant you didn’t fit in with the prevailing umwelt –with what you were supposed to be as a little boy- or maybe it was just a talisman raised to guard against the fear that despite its undesirability, it might be hiding in us all –even the accuser. Children are inherently superstitious, don’t you think?

It never occurred to me to wonder about the expression at the time, nor even later when I had children of my own. Babies cry, often too much, and perhaps more to the point, often at inconvenient times: during the nights. But I never suspected that it was sufficiently upsetting that it would transmute into folklore as a children’s curse. In fact, as childhood made way for my adult clothes, I didn’t think much about it at all -let alone as an imprecation- until I happened upon an article in the CBC News: http://www.cbc.ca/news/health/babies-crying-health-study-warwick-university-1.4052932 ‘Researchers at the University of Warwick conducted a meta-analysis of studies involving about 8,700 infants in countries including Canada, Germany, Denmark, Japan, Italy and the U.K.’ and guess what? ‘[…]babies in Canada, Britain, Italy and the Netherlands cry more than babies in other countries.’ And not only that, ‘On average, Canadian babies cried 30 minutes more than babies from other countries.’ Great! There goes our long held patriotic claim to be the ‘polite nation’ -the one usually definable by what we are not: (not American, not greedy, not pushy, not… Well, you get the point). ‘Canadian babies had some of the highest levels (peaking at three to four weeks at 34.1 per cent of infants), followed by the U.K. (peaking at one to two weeks at 28 per cent) and Italy (peaking at eight to nine weeks at 20.9 per cent).’ ‘Germany, Japan and Denmark had the least amount of crying and fussing babies.’ Damn.

Mind you, if you actually look at the article reported by the CBC:  http://www.jpeds.com/article/S0022-3476(17)30218-4/fulltext – s0070, ‘Overall, fuss/cry durations were high across the first 6 weeks of life, then reduced significantly over the following 6 weeks. All studies found a “universal” reduction in fuss/cry duration between 6 and 12 weeks of age.’ The reasons for the differences were not at all clear: ‘[…] we can only speculate on the reasons why there are country differences, in particular between Denmark and the rest of Europe and North America. These could range from economic conditions, such as less social inequality, to caretaking patterns such as responsiveness, carrying behavior and management in Denmark that have been shown to differ from the United Kingdom. However, there may also be population genetic differences, and the infants both inherit their parents’ genes and are reared by them (gene-environment correlation). […]Feeding type was a further moderator of fuss/cry duration. Bottle or mixed feeding was associated with reduced duration of fussing and crying or colic from 3-4 weeks of age onward. Switch in feeding type is one frequently adopted method by parents dealing with a crying baby and has been found to reduce crying regardless of what formula change is instituted, suggesting a placebo effect.’

Unfortunately, ‘[…]this is a review of studies in North America and parts of Europe with only 1 study from Japan. No studies from threshold or developing countries were available, but these would be needed to provide adequate feedback to parents on other continents. Feeding type information was also not available for some studies.’

And what about ‘colic’ the catch-all word for persistent crying? ‘The most widely used definition for colic is the “Rule of Three’s”: an infant is considered to have colic if the infant fusses or cries for >3 hours, >3 days per week, for >3 weeks.’ Unfortunately it is, apparently, often a diagnosis of despair with no readily identifiable cause. Indeed, ‘The rapid developmental change in fuss/cry duration has implications for treatment and interpretation of treatment studies. Colic is the extreme of normal fuss/cry behavior, self-limiting, and, thus, the vast majority will spontaneously remit. Adequate management of fussing and crying in the first 3 months rather than treatment may be required. However, if excessive fuss/cry persists beyond the first 3 months, there is increasing evidence that this may indicate regulatory problems with adverse consequences for future development and may require treatment.’

But, bringing it back to Canada, my terre natale, ‘Psychology professor Dieter Wolke, lead author of the study, says Canadian parents need not worry. […] He pointed out that babies in Canada peaked around the three-four week mark but fell into a more normal range around week six.’ …Damned by faint praise again…

And what about Germany, Japan and Denmark? Especially Denmark –why does it always seem to win everything? ‘”In Denmark, it seems to be they’re more relaxed about it,” Wolke said. “They might have a little bit more support because of maternity and paternity laws … the father in the first few weeks can stay at home, too.” It’s worth noting that Denmark regularly falls at or near the top of the “best countries to live in” lists. Wolke speculates that this may foster a population that feels good about itself, and those emotions can transfer to the baby.’

Uhmm, excuse me! ‘”Babies are already very different in how much they cry in the first weeks of life,” the researchers said. “There are large but normal variations”’. So let’s not dump on les petits Canadiens, eh? It’s a squeaky wheel that gets the grease, after all. Right? …I mean that’s right isn’t it…?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Stealing Steps of Age

Elderspeak. We’ve all heard it: baby-talk for seniors, an almost unconscious reaction to those we deem cognitively impaired, or hopelessly out of date. It’s a kind of pretend-communication with those who seem unreceptive, or beyond the pale of verbal comprehension.

Although the term is aptly descriptive and eerily evocative of rows of beds with wrinkled heads whose staring eyes peek out from where their bodies are tucked, I have to admit I had not heard the word before seeing an article in the CBC News. It described a study published in The Gerontologist about the way a group of nuns cared for their elderly colleagues from their convent: http://www.cbc.ca/news/health/nuns-elderly-1.4039508

‘The sisters caring for cognitively impaired elderly nuns in a Midwestern convent spoke to their care recipients in a way that sounded strikingly different to linguistic anthropologist Anna Corwin. The nuns rarely used “elderspeak” — a loud, slow, simple, patronizing and common form of baby talk for seniors. Instead, Corwin reports, they told jokes, stories and blessed the sick nuns, all the while speaking to them like they were completely capable, even though their ability to communicate was significantly diminished.’

‘The nuns in the infirmary suffered from dementia, Alzheimer’s disease, aphasia, stroke and neurological deterioration, and all had limited or impaired communication abilities. Sometimes the caregiver nuns held the sick nuns’ hands, and sometimes they massaged their legs, Corwin said.’

It all sounds so… sensible. So empathetic. And yet, so often we are frustrated by our apparent inability to effectively communicate that elderspeak becomes a sort of default –almost as if those to whom we are speaking are not really listening, or, depending on their condition, are minimally aware of our presence. And this can be especially prevalent among overworked care providers in geriatric wards.

‘Kristine Williams, a professor at the University of Kansas School of Nursing in Kansas City, trains nursing home providers to use less elderspeak. Her studies found that communication training can reduce the number of diminutives, terms of endearments and collective pronouns senior caregivers use.’ But training to do what?

The nuns offer an interesting option. ‘The caregiver nuns had long-established deep relationships with their elder charges, Williams noted. “They are in almost a family-like relationship, as opposed to someone who’s a nursing assistant in a home,” she said.’ And what they offered, was not condescension or inadvertent humiliation. Not patronage or mere toleration. ‘”They see these older adults, even when they’re lying in bed moaning and can’t move, as not being reduced by these chronic conditions but still as whole individuals.”’

The study was an interesting one, and yet its findings should not surprise us. ‘Beauty doth varnish age, as if newborn, and gives the crutch the cradle’s infancy’ as Shakespeare said. In other words, finding beauty in old age can transform it and make it bearable –in this case both for the aged as well as the caregiver.

Now that I think about it, I suspect I learned that years ago when I was a beginning medical student and visiting my aunt Shirley who was hospitalized after a stroke. She was stored –that’s the only word to describe it- in an older part of an already-old hospital on a ward –a large room, really- lined on both walls with beds like a dormitory. And for the most part, as I described above, all one could see looking down the rows were heads peeking out from neatly tucked bedsheets, white hair splayed across the pillows or stuck to the scalp with sweat. Some had eyes that moved, but mostly it was a room of mouths –none speaking, all busy with just the chore of breathing.

Shirley was one of the exceptions, propped as she was by a series of pillows and a cloth bib whose tethers kept her from tipping over the bed railings and onto the floor. Her voice was slurred and indistinct, so I had trouble hearing what she had to say, but I could tell she was getting better because she was complaining about the woman in the bed next to hers.

“There’s nothing there,” she kept saying, her eyes pointed at the head beside her that was staring, unblinking, at the ceiling. “They’ve put me in an empty room, dear, and I don’t like it.”

My aunt had always been gregarious, some might even say nosy, so to be confined to a room where she couldn’t extract vital gossip and life histories, was a type of exile for her. A punishment.

“You seem to have improved each time I come here,” I said, trying to cheer her up. For my part, the ward depressed me. “They’re obviously treating you well,” I added, quickly running out of small talk.

Part of her mouth smiled, but most of her face seemed still asleep. Not at all happy.

“Your aunt is improving, sir,” a soft voice said from behind me.

I turned and saw a short, smiling, grey-haired nurse dressed in white trousers and a white shirt buttoned up to his neck. His eyes were twinkling, and he was gazing at my aunt as if he, too, was proud of what she’d accomplished. There weren’t very many male nurses then, so I was surprised. “I expect they’ll be transferring you to another ward, soon, Shirl,” he added locking her eyes in his and ignoring me for a moment. “So quit complaining, eh?” He chuckled when he saw her smile broaden and the rest of her face follow suit. He reached out and squeezed her toe through the sheet and wandered off to check on the next bed. Shirley giggled, obviously pleased.

I could hear the nurse talking to that unresponsive woman in the next bed, although he spoke quietly. First, he tilted his head to stare at the ceiling above her bed. Then, he smiled. “You know, Liz, I figure you must have much better eyes than me…” He liberated a skeletal arm whose flesh hung from it like curtains on a window and held it tenderly. “…Because no matter how often I look, I still can’t see whatever it is that you find so interesting up there.” He gently squeezed her hand. “We’re gonna have to discuss this over a beer someday, eh?”

Her face didn’t change, but her breathing seemed a little less laboured. A little slower. More even. “Anyway, is there anything you need me to help you with today?” he said as he ever so gently massaged her arm then flexed and relaxed her fingers. When he’d finished with that arm, he tucked it under the sheets again and repeated the exercise on the other. “I’m going to come back and move you into a different position in a few minutes, Liz, so don’t get too comfortable like that, eh?” He loosened the sheets around her and raised the railings around the bed again that guarded her from falling. “And I’m going to make sure that physiotherapist you like comes with me to massage your legs.” He winked at her flirtatiously and gave her leg a squeeze through the sheet.

“He might as well be talking to the pillow,” Shirley whispered, as he busied himself with the railing. “All she does is stare at the ceiling. She doesn’t seem to notice when I talk to her…”

“So wait for me, Liz. I don’t want to have to go looking all over the ward for you again,” he said, laughing, and wandered off to yet another bed.

“I do like Bill,” Shirley said when he was out of earshot. “He treats us all like family –like we matter.” She was silent for a moment and then, just when I was about to leave, she managed to snag me with her good hand. “But I don’t know how he stays so cheerful here. I think half of the patients don’t even know he’s talking to them.” And her eyes wandered over to the woman in the next bed again. “It must be terribly discouraging for him, don’t you think?”

I glanced at the woman, and for a moment, I thought I saw her eyes flicker as if they were searching for something. Someone. And then, a tear? But maybe it was just a trick of the light, because, as her face relaxed a tiny bit, they closed and she began to snore. Not loudly, not as if she couldn’t breathe –but quietly, comfortably, and slipped from the waking dream, into yet another more peaceful one further inside.

 

 

 

 

 

 

 

Time Out, eh?

Time-outs to wring behavioural change from naughty children are all the rage nowadays. Everywhere you go there seem to be men sitting near their tantrum-laden little boys in the parking lots of stores, or women standing outside of cars fastidiously ignoring the screams of alternately pounding and pouting children confined within. Perhaps this has been going on for years, but only recently have I begun to notice the ritual. In fact, it seems so ubiquitous, that I am beginning to suspect a flaw in my own upbringing. I don’t remember being an easy child; maybe I just had easy parents. Or maybe the Encyclopedia Britannica of the age didn’t cover that aspect of childrearing.

It might be investigating the obvious, but I had to look it up at any rate. Time-outs are more acceptable attempts at behaviour modification than corporal punishment –spanking comes to mind- especially in public, where the difference between remonstration and child abuse is uncomfortably opaque. The idea of social exclusion was likely popularized in a paper by a Dr. Montrose Wolf at the University of Washington in the mid 60ies, drawing on the work by his mentor, Dr. Arthur Staats (who called it ‘time-out’).

But, unless you grew up in Winnipeg in the 1950ies, you might now regard time-outs as such an intuitively obvious way of treating both the child’s misbehaviour and the resultant parental frustration, that you would be forgiven for assuming it had been hard-wired in our DNA. Perhaps it was, but with variable penetrance, and probable mid-prairie epigenetic modification –anyway, there seem to be some issues with its application: http://www.cbc.ca/news/health/time-outs-study-parenting-1.3888166

By default, I suppose I’m an educationally impoverished repository of doctrinal wisdom when it comes to children. As an obstetrician, for years -until my own arrived, at least- my responsibilities ended with handing the freshly-liberated, and usually screaming newborn to the mother, tidying things up, and then congratulating the smiling, emotionally overcome parents before I left the room. I didn’t expect to be confronted with any of their subsequent behavioural peccadillos. But, as Shakespeare’s Cleopatra remarked, those were ‘my salad days, when I was green in judgment’.

Usually, I enjoy seeing children in the waiting room –they lend a kind of friendly family air to the office. Sometimes, however, there are things I need to discuss with the mother, procedures I need to perform, or even examinations that might alarm the child, so my enjoyment is often that of seeing the child stay in the waiting room. It’s not called that for nothing.

Clara was already a harried teenage mother of a two year old when I first met her several years ago, and I delivered three more for her in the following years. Now in her late twenties and recently divorced, she had been sent to see me for permanent birth control.

I heard the excited screaming even before I reached the front desk, and I have to admit that I hid behind a wall to assess the situation more fully before I ventured into the open. The first of the children I delivered -Edward, now around five- was stirring the pot by running around the room clutching a toy to his chest so the dauphin, despite the obvious entitlement of age, could not get it.

Clara’s long auburn hair, now partially liberated from whatever restraints she’d attempted at home, was hanging forlornly around her shoulders, while her eyes followed the action around the room like a hockey game. A large lady now, she sat uncomfortably on the edge of her seat, no doubt hoping to catch Edward and the toy if he was so unwise as to come anywhere near grabbing range. The youngest, still breast feeding, was the only one over whom she exercised even temporary dominion.

I glanced nervously around the room from the shelter of the alcove, hoping she had brought a friend or older family member with her, but Clara was the last patient of the day and the room was otherwise empty.

“Clara,” I said, face prepared, and hoping she hadn’t noticed me behind the wall. “Nice to see you again.”

The children immediately stopped running and flocked to my side to tug on my clothes. Jamie, the oldest, grabbed the toy from Edward, who was now too busy trying to reach my stethoscope to notice.

“I… I saw you… watching from the alcove, doctor,” Clara said, blushing a deep crimson because she almost said ‘hiding’. “I tried to get my sister to take care of the kids, but she had to work today…” She shrugged and reached out with lightning speed to grab Jamie’s arm before he could swat his brother. “You behave yourself, Jamie, or you’re gonna do a Time-out, eh?”

Jamie immediately akimboed his arms and made a face at his brother. “He grabbed my car…!”

Clara glared at him and frowned, but from the defiant face with which Jamie greeted the threat, I could see the battle lines hardening.

I glanced at my secretary sitting behind the front desk, but she was on the phone and I realized that I was on my own. “Let’s go into my office,” I said, with a worried look at the boys, and the little girl, Janice, who by now had decided that the way to recapture some attention was to stick her tongue out at Jamie. Only the baby seemed compliant, but that was probably because Clara was still nursing her.

My office, unfortunately, was not designed for children –there are simply too many things that could tip over or break if handled indelicately. On the way down the hall to the office, I even thought of getting my secretary to fake a call from the hospital requiring my immediate assistance, but she was still on the phone and merely winked at me as I passed. I got the impression she was just holding the receiver for show.

As soon as the troupe entered the office they began to explore, and Jamie, who had probably never seen pennies before, made a quick exploratory lunge for the penny bowl that sat in front of a terra cotta statue of a begging lady precariously balanced on a little oak table. Edward, on the other hand, was reaching for the carved wooden statue of a woman holding a child that I had put behind a plant on my desk, and Janice was trying to extract the contents of the shelf where I keep my medical journals. It was a multi-pronged attack worthy of an Alexander.

“I’m not sure this is going to work, doctor,” Clara said, trying unsuccessfully to reposition the baby onto a breast while glaring at all three of her children now crawling along the floor scooping pennies into their pockets.

I called my receptionist to come in with us. “Laura,” I said as she opened the door a crack and peeked in. “Please put the phone on hold, or something…  I need your help.” Actually, I needed a time-out.

I could feel Laura’s eyes rolling behind the door. She was the mother of three young children, so she knew what I was going to ask.

“I want you to take the kids and… occupy them for a few minutes while I talk to Clara.”

She shrugged, but I could tell from her face that she thought it might be an interesting challenge as she gathered the tribe -minus the now sleeping baby- and led it out of the door. The office felt so peaceful suddenly that Clara and I just looked at each other for a moment. I managed to gather a more complete history and when I opened the door to lead her across the hall to the examining room I could only hear quiet giggles.

Finally, after Clara and I had discussed her needs, we both tiptoed down the corridor to the waiting room. But it, too, was quiet except for Laura’s voice telling a story as the children sat around her in a little circle on the floor.

Each of them had a plastic speculum with a sticker face stuck on the top and when Laura asked a question, one of the children would make the speculum talk. They were loving it and didn’t even look up when we crossed the rug. But Laura did, her eyes glistening from quiet laughter.

Clara just stared at them, unable to speak.

Laura chuckled and then shrugged. “I gave each of them a choice of those little funny face stickers we always give to the kids and showed them how to attach them to the top of the speculum.” A contented sigh escaped as she watched them all talking quietly to each other through the specula. “From then on, it was just role playing…”

“How did you ever think of that, Laura?” I asked when they’d all left.

She shrugged again. “The specula have always reminded me of quidnuncs… you know, snoops -those who insist on sticking their noses in other people’s business.”

I had to sigh in admiration -Laura has a name for everything. I just hope she doesn’t expect me to name the specula now… But I looked up quidnunc just in case.