More than kin, and less than kind

 

Puberty is seldom easy nowadays, although in fairness, I suppose it never really was. From the Latin pubertas -adulthood- it is a time of eventful and often embarrassing change as children pass through a bewildering array of morphological and psychological alterations on their way to the adults they are programmed to become.

For boys, I think they are largely awkward times -the voice changes, and the soft and downy facial hair that seems to take forever to coarsen enough to become a beard: the apparently interminable and disconcerting interregna between child adult.

For girls, I think, it can be more than merely embarrassing, because amongst other things, they may begin to develop adult contours before their brain has matured enough to fully understand the effects that might have on others.

A few years ago, when my dog was just a puppy, I remember sitting on a park bench trying to read after taking him for a walk. The dog, with his large puppy eyes and waggy tail, was attempting to befriend everything that walked past, however, so I put the book away and was about to leave, when I saw a woman and a younger girl further along the trail glancing our way. The woman pointed at the puppy, but the girl seemed reluctant to approach any closer, although she was clearly interested.

I assumed the girl might be frightened of dogs, but puppies have a way of overcoming that, so I smiled at the two of them and asked if they wanted to pet him. They talked about it for a while, and then the woman gently grasped the young girl’s hand and led her over to the puppy.

“Suzie’s sometimes a bit shy,” she said, smiling at me and sat beside me on the bench while her daughter patted the squirming and delighted dog. Suzie, dressed in a grey sweatshirt, jeans, and a baseball cap, was the mirror image of her mother. Perhaps fourteen or fifteen years of age, she did seem unusually shy, however, especially since her mother had no difficulty striking up a conversation with me.

Rolling around on the grass with the dog, Suzie seemed completely at ease with the puppy, and I thought she might enjoy taking it for a little walk in the field in front of the bench. I offered her the leash, but I could see her eyes change with the gesture. Suddenly suspicious, she glanced at her mother, like an uneasy child.

He mother chuckled, took the proffered leash from my hand and gave it to Suzie. “By the way, my name is Martha,” she said, extending her hand, as we introduced each other. “I’m afraid Suzie’s really shy around strangers -unlike her mother,” she explained, once her daughter had run off with the dog. “And especially around men,” she added, studying my face for a reaction. Then, just as suddenly, her expression softened. “She’s only 11, even though she looks 13 or 14, so I suspect she’ll outgrow her fear…”

“Fear…?” I said, instantly regretting my question, but there was something in her eyes that made me need to ask.

The woman stared at me for a moment, as if trying to decide whether or not to answer,  and then shrugged. “She’s going through puberty a lot earlier than I did…” She blushed, as much at the word, as in disclosing it to a total stranger on a park bench. “So she’s beginning to develop… “ She paused for a moment to find a better word. “She’s beginning to look older than her age, let’s say…” Then she looked down at her lap, and clasped her hands for a second. “And now older boys -and men as well- look at her… differently.” Her eyes suddenly walked across my face before they settled on the field where Suzie was running. “I don’t think her mind has caught up with her body yet, and it confuses her.” I sensed that Martha was more worried than she was willing to let on, though.

When Suzie returned, flushed and breathless from her romp in the field, she seemed more relaxed and thanked me for letting her play with the puppy, but a few minutes after the two of them left, I almost forgot about the incident -it was only one of many encounters I had with the new puppy- and yet I have to admit to a lingering concern about the occasion. Many years later, I came across an article in a BBC Future series that started me wondering again: http://www.bbc.com/future/story/20180611-the-health-risks-of-girls-maturing-early

‘[S]exual harassment of minors remains a less common topic of discussion – though it’s one that may have increasing urgency, as puberty seems to be coming earlier for increasing numbers of girls across the globe. While the average age of puberty onset, defined by breast development, for US girls  was almost 12 years old in the 1970s, it fell to nine years by 2011… ‘Girls who reach puberty earlier are sexually harassed more than their peers, regardless of whether they’re engaging in sexual behaviours earlier.’

‘Enduring unwanted comments and stares may seem minor compared to other types of sexual violence. Still, studies have shown they can be particularly distressing for a child,  putting them at risk of psychological problems that can reverberate throughout their life.’

‘Although puberty presents challenges for all adolescents, girls who mature ahead of their peers are particularly vulnerable. One recent study, which tracked more than 7,000 women over a period of 14 years, found that early menarche (the first menstrual bleeding) was associated with  elevated rates of depression, substance abuse, eating disorders, and antisocial behaviours in adulthood.’ Also, ‘In the UK, one recent BBC investigation found that children as young as six years old have been sexually assaulted on trains or in train stations.’

‘The important thing about puberty is that it’s visible to others. But a young girl with breasts is no less of a child, or better able to handle such a situation, than one who hasn’t yet developed… Sexualisation of girls is especially problematic in cultures where puberty automatically tags a girl as ready for marriage.’ In fact, closer to home, ‘Unchained at a Glance, a nonprofit dedicated to helping women and girls in the US escape forced marriages, has estimated that 248,000 children as young as 12 were married in the US between 2000-2010.’

Of course not all girls are traumatized by precocious development, and ‘Researchers agree that it’s important not to catastrophise about early sexual development in and of itself. The problem isn’t that a girl’s body is changing. It’s society’s response to it. As a result, they say we should think about how we might support girls and their families best.’

Looking back, I wonder now if Martha had just been gauging my reaction? Curious how I had judged her daughter. I hope she saw me as a man merely watching a child playing happily with a puppy. That’s how I saw me, at any rate…

Advertisements

The Problem of Puberty

Puberty is alchemy, don’t you think? Like the chrysalis of a butterfly, the girl emerges from the pupal case of her childhood into an adolescent -an almost-woman- with hormones ablaze. It is a magic time of change, both in growth and physiology, but also in cognitive development. It is a time of evolving expectations, but more slowly developing judgement –the brain, too, is undergoing renovations. Hence our oft-aggrandized memories of the time –not deceptions, exactly, but distortions. To paraphrase Napoleon: history is the version of past events that I have decided to agree upon.

Many of the manifestations we see of puberty are the confusion of autonomies –the challenges to the boundaries that society imposes. I think Wikipedia has summarized the issues quite succinctly: ‘Psychologists have identified three main types of autonomy: emotional independence, behavioral autonomy, and cognitive autonomy. Emotional autonomy is defined in terms of an adolescent’s relationships with others, and often includes the development of more mature emotional connections with adults and peers. Behavioral autonomy encompasses an adolescent’s developing ability to regulate his or her own behavior, to act on personal decisions, and to self-govern. Cultural differences are especially visible in this category because it concerns issues of dating, social time with peers, and time-management decisions. Cognitive autonomy describes the capacity for an adolescent to partake in processes of independent reasoning and decision-making without excessive reliance on social validation.’ It is obviously a special and bewildering, albeit a magical  time. A time for planting the crop that is to come…

Because there are so many physiological processes involved, the actual start of puberty has always been approximate. Genes no doubt play a major role in its onset, but nutrition and general health are obviously involved as well because puberty is changing –it’s starting earlier. As an article from BBC news reports: The age of puberty is changing around the world. In the UK it is currently starting about one month earlier every decade. In China it is more than four months earlier every decade. http://www.bbc.com/news/health-33168864

Of course, we have an almost obsessive need to analyze every change –to match every nuance with some overly reductionist, albeit plausible, explanation. Meat, for example. Yes, I’m serious: http://www.bbc.com/news/10287358  Although it’s an older study, and Vegan-unreferenced, I have to wonder if they could have equally successfully used milk consumption, or perhaps eggs, or even Starbucks coffee… 

But whatever the causes of earlier puberty, that very change may have unexpected –and perhaps unwanted- ramifications as the MRC Epidemiology Unit  at the University of Cambridge recently published using the data of almost half a million people from the UK Biobank: http://www.nature.com/srep/2015/150618/srep11208/full/srep11208.html

Doesn’t it seem strange that improving health and nutrition could have untoward, unintended consequences, although somewhat removed in time and maturity? Perhaps targetable with preventive interventions to be sure, as the authors point out in their abstract, but nonetheless ironic –the Red Queen needing to run faster and faster to stay in the same spot…

The most convincing evidence of the effect of an earlier puberty, apparently, is in its association with higher risks for type 2 diabetes and cardiovascular disease in women. A simple reasoned path to the type 2 diabetes (and its well known association with obesity) might be that: ‘early childhood rapid growth and overweight precede early puberty timing in both sexes, but in turn early puberty timing leads to subsequent rapid gains in weight and adiposity during adolescence and early adulthood’, but this may be an over-simplification of one of many factors that may be contributing –longer exposure to hormones, say, or life-style decisions altered by earlier maturation than peers: ‘environmental stressors may precede early puberty, but in turn early puberty leads to more risk taking behaviours and poor school performance.’ Intriguing, but speculative to say the least.

And on the more optimistic side of changing pubertal age? Well… there is a trend towards a lower risk for breast cancer in those with a later onset of puberty –although in fairness, this is likely related to a decreased time of exposure to hormones, so I’m not sure if it isn’t just a bit of trade-off… And anyway, trend is often what you call something that is not statistically significant (and yet perhaps lends credence to your hypothesis?).

But are we simply treading water in storm-tossed seas?  At risk of drowning in the details of semi-focused data swirling around us –most of which, at least in this case, was dependent on self reported medical histories and events that happened years before? Admittedly, the age of the first period is probably recalled with fair accuracy by most women –it is an event like few others- but aren’t researchers as seduced by this form of reasoning as the rest of us: the development of diabetes just begging for a scapegoat? So, choose the goat, widen the parameters, and voila…

An illustrative example of how easy it is to be led astray: many years ago, before we knew very much about the causal agent for cancer of the cervix (it is now known to be the human papilloma virus) but had pretty well decided it was something infectious –something sexually transmitted at any rate- the herpes virus came under scrutiny. It was infectious; many women exhibiting it also had abnormal pap smears suggesting precursor lesions for cervix cancer; and it was obvious –women who developed herpes were almost always aware of it. Herpes was easy to blame, because it was fairly straightforward to date the pap smear problem to some time after the event of acquisition. Everything fit –except it was not the cause. Not only did people who had never experienced herpes also develop abnormal pap smears, but similarly, not all people with herpes developed pap smear changes. The recall was an easy data point -something to blame- it’s just that it was the wrong thing.

My point is, it can be misleading to attribute cause merely based on recallable events. We all require explanations -something to blame. But, Post hoc ergo propter hoc? Well, the Latin may sound authoritative but not in Medicine. It is a logical fallacy…

This is all unfair to the study I know; I don’t mean to cast aspersions on either the researchers or their methodology, and yet I can’t help but worry about reports of this kind. Huge data bases are tempting geologies for data mining. But association is not necessarily causation.

As the humorist James Thurber once wrote: ‘Well, if I called the wrong number, why did you answer the phone?’ –just in case, I guess…