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The Identified Patient = Health & Care (Pt 3)

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I’ve had the privilege of hearing Sir Richard Bowlby speak on at least two occasions that I can remember. One talk in particular comes to mind.

Back in 2005, Sir Richard Bowlby presented a paper entitled Attachment Relationships in Later Life.[1] Sir Richard, in a candid moment, told us about the frustration his father, John Bowlby, would often experience in the aftermath of the 1969 release of Bowlby’s first volume[2] of his three-volume set on attachment theory and functioning. According to Sir Richard’s account, his father assumed that once it could be shown that care—especially the early care a mother provides to her infant—could be placed within a scientific framework and evaluated scientifically, the world, especially mothers, would thank him. Bowlby reasoned that once it could be shown scientifically that early safe and secure attachment relationships are important for the proper psychological and social development of the infant/child, not only would prestige be placed upon these early care relationships, but so too money and investments would begin to flow as a way of supporting these relationships. As developmental psychologist and education expert Howard Gardner puts it in his 1983 book entitled Frames of Mind: The Theory of Multiple Intelligences:

Various forms of personal intelligence arise, in the first instance, from the bond between the infant and its caretaker—in almost all cases, the infant and its mother. Evolutionary and cultural history have combined to make this attachment link an indispensable component of normal growth.[3]

None of this happened: no prestige for mothers, no new infusion of money, and no investmnent in the early mother-infant attachment relationship that Gardner calls “indispensable.” What frustrated Bowlby the most was that very little changed. In fact, Sir Richard told us that his father had planned on only writing one book on attachment. He ultimately wrote two more volumes on the various facets of attachment (released in 1973 and 1980 respectively) hoping that, through dogged British determination, eventually his message would catch on. Sure, it did have some modest effect, namely, many hospitals did away with their restrictions prohibiting parents from visiting their children, especially during long stays. What happened that Bowlby’s theory of attachment (i.e., early mother-child care) never took off?

Welcome to Part 3 of my four-part series wherein I frame the DEI movement using the analogy of family systems theory with its focus on the identified patient. (See Part 1 for a description of this analogy and why I’m using it.) Briefly, I argue that DEI uses historical events such as slavery and the displacement of Native Americans as identified patients. While these identified patients do allow for the consolidation of a coherent identity, they also cover over hidden issues that the “family system” does not wish to look at or otherwise consider. In this post we will look at the hidden issues of Health & Care (having looked at the hidden issues of automation and money previously).

I have used the following quote many times in my blogs and books. And I will probably use it many times more. In my mind, it’s an important quote because it so clearly represents the fissure that opened up between Bowlby’s theory of attachment (and, by extension, care) and the direction that emancipation psychology wished to go in.

Writing in her 1999 article entitled Why Is Attachment in the Air?, feminist psychoanalyst Susie Orbach tells us that “[f]eminist analysts first had a difficult time with what they perceived as Bowlby’s [scientific] valourisation of the maternal at a moment when we were trying to [sociologically] understand the relationship of women’s oppression to the structure of the nuclear family.” Orbach continues, “Bowlby’s [scientific] observation of the child’s need of the mother was just the kind of presumption that needed [postmodern] deconstructing.” In essence, feminists took an anti-science stance towards Bowlby’s work, and, instead, framed it using the emancipatory trends contained in postmodernism, which, back in the 1960s and 70s, was gaining popularity within certain academic circles. Again, according to Sir Richard, John Bowlby thought that framing “mothering” and “maternal care” using science would be a good thing, one that would be embraced by not only women but also by politicians and policymakers. Feminists of an emancipatory bent looked at it differently.

Yes, feminists who focused on emancipation recognized that the framing of mothering by science revealed that mothering was a very complex and involved process that took decades to complete. However, at the same time they saw mothering as an under-appreciated, underpaid (as in no pay), and imprisoning endeavor. “Forget science,” they probably shouted, and that was probably not the F-word they used. Feminists framed Bowlby’s work as a form of biological determinism, that is to say, a woman’s biology traps her in the role of caregiver, especially as caregiver to infants and young children. (This is the message we find in the book Forced to Care, which I  mention below.) Feminists wished to emancipate women from their biology and the biology of innate behavioral systems such as attachment. This, I would argue, is one of the early forms that emancipation psychology took back in the late 1960s and into the 70s and 80s.[4]

Today emancipation psychology forms the foundation upon which rests many forms of “critical analysis,” from critical race theory, to critical animal theory, to critical plant theory, and yes, the DEI movement (diversity, equity, inclusion). For more on this theme, see the 2018 book entitled The Emancipation Project of Posthumanism by Erika Cudworth and Stephen Hobden. I should point out that Cudworth is Professor of Feminist Animal Studies in the School of Social Sciences, University of East London. Cudworth calls predominantly white male colonists “humans” who invade, conquer, and extract (as in extracting oil and minerals from the Earth). In Cudworth’s mind, “posthumans,”—who will be predominantly people of color and not overly concerned with gender—will not invade, conquer, nor extract. Cudworth calls for the replacement of humans by posthumans so that the planet can be ultimately saved. I do admit that Cudworth and Hobden’s book helped me to recognize that the word “critical” when used to describe race, or the plight of animals, or the plight of plants, is not being used in the sense of “critical thinking.” Critical in these contexts means “to find, expose, and release people from processes that bring about imprisonment of some kind,” like women’s biology.

Another good book on these themes is Evelyn Nando Glenn’s 2012 book entitled Forced to Care: Coercion and Caregiving in America (mentioned above). OK, I’ll add a third book here: Mary Eberstadt’s 2004 book entitled Home-Alone America: The Hidden Toll of Day Care, Behavioral Drugs, and Other Parent Substitutes. Eberstadt points out that early on feminists promoting emancipation psychology ran into a problem: if we (feminists) emancipate women from biology (and the children biology creates, at least for now), what will become of those children? So, as Eberstadt talks about, a plan was put into place to find and employ all manner of parent substitutes, such as daycare and behavioral drugs like those commonly used to treat ADHD (attention deficit and hyperactivity disorder) such as Ritalin and Adderall. Now, keep in mind that Eberstadt was writing before iPhones and other screen devices were also put into service as parent substitutes (which ties back to my thoughts on automation).

Ironically, Bowlby’s work could be framed as taking a look at what would happen when children are separated from their primary attachment figure, typically the mother, and put into the care of parent substitutes or, in some cases, no parents at all. As Ebestadt points out, many parent substitutes create what is known as “parentification,” which is the process whereby children are left to raise themselves (the latchkey kids of the 1970s and 80s would be an example here[4]). Bowlby, in no uncertain terms, stated that parentification and its close cousin, role-reversal (kids parenting adults), comprised the royal highway toward insecure attachment. It is no wonder feminist psychoanalysts and psychologists turned a blind eye toward Bowlby’s work because had they considered it (as Orbach suggested they should have[5]), they would have realized that emancipating children was a formula for disaster, a theme that Ebertstadt takes up in the bulk of her book. In systems terms, the emancipation project had a number of rather nasty unintended consequences.

That disaster is with us today as more and more children and young people are not able to do for themselves and are unable to regulate emotions. The main message modern attachment theorists, such as Allan Schore, Louis Cozolino, Peter Fonagy, and Daniel Siegel, give us is this: early safe and secure attachment relationships are the royal highway toward appropriate and well-developed forms of emotional regulation. In turn, emotional regulation then allows for the development of robust Executive Function skills such as reflection, critical thinking, empathy, planning, etc. This message has been out there since the mid-1990s when Allan Schore released his now groundbreaking book entitled Affect Regulation and the Origin of the Self (1994).

Today, we have a new “condition” known as “after-school restraint collapse.” This is when kids in grade school come home and literally fall apart in an emotionally dysregulate state. And parents are being told by so-called experts that there is nothing to worry about. Really? I’m sorry (my dander now flying) but any child who enters an emotionally dysregulated state is in psychological crisis, plain and simple. And these states have the potential to do significant psychological damage. I have no other way of framing this “condition” than to simply say, “this is not good, really not good.” Mental health professionals should be out in the streets sounding the alarm. But I hear no alarms going off. It would appear that attempts to emancipate kids from restraint is actually resulting in psychological and social trauma, a rather pernicious negative feedback loop. One person sounding the alarm is Dr. Means (mentioned earlier), whose work we will look at below in a moment.

—oOo—

Back in the 2000s I attended a national gathering of the Council on Foundations in Denver. I went to a breakout session on how well the U.S. was doing compared to other developed countries. If I were to ask you Where does the U.S. fall in terms of infant mortality? what might your answer be? Now, you may logic, Well, we’re probably not as good as the Scandinavian countries but close, say, fourth or fifth place. Back in the 2000s when I attended this conference, the U.S. ranked number 23, just below Cuba. I was shocked! And the education achievement numbers were equally dismal. But let’s stay with infant mortality for a moment. The presenter (whose name I cannot remember, sorry) told us that, in terms of infant mortality, Cuba passed the U.S. in an unusual way. Apparently Cuba knew they did not have the money to invest in sophisticated measures designed to improve infant mortality. So, they went old school. They launched a campaign designed to get mothers to breastfeed their infants/young children, and for longer periods of time. It worked. The presenter also noted that Cuba does not have ready access to what is known as “junk baby formula and food.” Apparently here in the U.S. junk baby formula and food not only encourage mothers to not breastfeed (thus greatly compromising early attachment), but they also do not provide all of the necessary nutrition that babies/young children need for healthy development.

Out of curiosity I just checked to see where the U.S. stands today with respect to infant mortality. Care to wager a guess? According to a 2023 USAFacts.org article, “The US ranked 54th in infant mortality out of 227 measured countries and territories at a predicted rate of 5.12 deaths per 1,000 births. This rate is a preliminary estimate for 2023, and is subject to change depending on up-to-date CDC data.”[6] And as you might expect, rates are higher for groups such as African Americans, Native Hawaiians, and Native Americans. Junk baby formula and food manufacturers were only too happy to help mothers separate from their infants/young children. Is this a form of disaster capitalism? Yes. But as we will see in a moment, junk food is a huge industry here in the U.S. that affects all of us, young and old. This is where Dr. Means’ work comes into the picture.

Dr. Casey Means wrote the 2024 book Good Energy along with her brother Calley, who used to provide lobbying services to the food industry. According to her book and the many YouTube interviews Dr. Means has conducted,[7] she quit her job as chief resident after five years of her residency as a head and neck surgeon. Dr. Means was literally months away from a guaranteed job that paid in the mid-six figures. As mentioned earlier, Dr. Means had racked up about half a million dollars in student debt. Who in their right mind would leave a five-year residency months away from completion and risk not getting a job that had the potential to erase 500K in debt in a reasonable timeframe. This is madness! Or is it?

Dr. Means, as she tells it, became increasingly concerned that medicine had become extremely reductionistic: both by creating narrow speciality upon narrow specialty as well as by reducing people from complex organic systems to a bunch of isolated parts, like a bone in the ear or a nose septum. Dr. Means found herself performing neck and head operations without ever asking, “Why is it that this person is sick, is coming back time and time again for the same inflammations or irritations?” Dr. Means started asking systems questions, not unlike the systems questions Sweden began asking in the 1930s as they saw their birthrate begin to fall.[8] The medical community did not take kindly to this line of systems inquiry. Dr. Means could no longer countenance turning human beings and their lives into a collection of isolated parts. She quit. My reaction to hearing this story was along the lines of, “This may well be one of the most brave people I have encountered.” But wait. I’ve encountered an equally brave person who also could not countenance turning human beings and their lives into a collection of isolated parts: John Bowlby. Bowlby will be remembered for many things. However, he is rarely remembered for his embrace of organic systems theory.[9] By promoting his theory of attachment, Bowlby was also promoting a move away from strict reductionism (e.g., behaviorism) and toward organic systems theory and evolutionary psychology (Darwin’s theory of evolution being a theory of systems par excellence).

So, I think there are two big overarching points that Dr. Means, aided by her brother’s take on the food industry, makes. The first is how much the U.S. and the U.S. economy is in love with reductionism, turning people into a collection of isolated parts. The second has to do with what Dr. Means effectively calls the COVID Stress Test.

Dr. Means suggests that we should look at the COVID pandemic as a nationwide health stress test. And the U.S. failed. It is no secret that certain health conditions put one at risk for not only getting COVID, but also getting a severe case requiring hospitalization. Health risks such as diabetes, heart disease, obesity, and others, increased mortality levels significantly. According to Dr. Means, even before the pandemic hit, the U.S. was seeing increases in such health conditions as obesity, depression, infertility, erectile dysfunction, and dementia, while life expectancy, for the first time, began to drop. In the YouTube video I have linked to below, Dr. Means simply asks, “Why is it that in the U.S. we spend 4.3 trillion dollars on healthcare costs and we continue to get sicker?” As she puts it, it’s this “asking why” that got her into trouble with the medical community. Dr. Means was opening the lid to Pandora’s box. COVID in many respects made it abundantly clear just how sick we are as a nation. What is driving this?

In Dr. Means’ opinion, and I get the impression many agree, it’s due in large part to the junk food industry and its devastating effects on mitochondrial health. (Mitochondria comprise that part of a cell, an organelle, that converts food energy into the biochemical energy that cells need to do their work.) In Good Energy, Calley Means talks about how the tobacco industry, recognizing that its core industry—selling cigarettes—was in trouble because the U.S. finally caught on that cigarette smoking was dangerous, decided to move toward growing and selling food. Supported by U.S. food subsidies, big tobacco—now big food—started to grow and distribute grains (that were later refined) and sugars (e.g., actual sugar or sugar in the form of corn syrup), which make up the bulk of junk food according to Dr. Means. In essence, we are slowly eating (i.e., poisoning) ourselves to death. More disaster capitalism? Yes. And, again, junk food disproportionately affects poor families and people of color. Why? Simply because good healthy food is very expensive. I discovered this when I had to wean myself off of a steady diet of frozen entrées that were making me sick, and buy ingredients at my local health food store so that I could cook my own meals, a huge lifestyle change for me. If the DEI movement is serious about emancipating people from forms of enslavement, the hidden issue of junk food, both for infants and adults alike, would be a great place to start. Heck, just this morning my Yahoo News feed presented me with an article that links Alzheimer’s with gut health.[10] Can you imagine reducing the number and severity of Alzheimer’s cases simply through good nutrition? Where’s the money in that (I ask snidely)? OK, how about this October 4th 2024 article by Felicity Nelson entitled Study of 500,000 Medical Records Links Viruses With Alzheimer’s Again And Again.[11] Nelson’s article points to a huge study that makes Dr. Means’ point: irritations and inflammations at the cellular level are associated with an increased risk of developing conditions such as Alzheimer’s.

I’ll leave it there. In Part 4, Closing Thoughts, I will wrap things up by providing an overview of the DEI family system we have been looking at. I’ll try to make the case that, yes, cultural oppression is real and needs to be properly mourned. However, there are myriad forms of imprisonment and oppression taking place today that need our attention from automation, to student debt, to abandoned children, to food that is making us sick. I would suggest that Dr. Means, like Bowlby before her, is pointing us toward a possible solution: wean the U.S. off of its dependency on reductionism and move it toward a more systems or holistic view of things. See you in a couple of weeks. In the mean time, take a look at the YouTube video I have linked to below in the Notes that profiles Dr. Means’ work. I can say for myself that Dr. Means’ story and work has opened my eyes. I hope maybe it will open yours as well.

Postscript: For those of you who think that all of this Good Energy is so much liberal brouhaha, I present for your consideration this video by someone who has a distinguished career in the military and is as skeptical as one can be. The video is by Chase Hughes (who I have mentioned before), one of the four members who put out content on the YouTube channel The Behavior Panel. I would suggest that Hughes came at the Good Energy landscape from a totally different direction (that of saving his brain) and arrived at effectively the same place Dr. Means did. Both ask the same probing “why” question: why is there all of this scientific research and data in support of Good Energy and it remains largely hidden? Are these not the same family systems questions raised by the identified patient and family secrets? (We will look at family secrets in the next post.) Exactly who is that man behind the curtain?

 

NOTES:

[1] – This presentation took place in 2005 in Canmore, Alberta, Canada, as a part of the Attachment Across the Life Span Conference hosted by The Rocky Mountain Play Therapy Association.

[2]- Volume I (1969/1982) is entitled Attachment and Loss, vol. I, Attachment (Second Edition, New York: Basic Books).

[3] – Gardner, who is not known for work in the area of attachment theory and functioning, provides an excellent synopsis of work by Bowlby and ethologist Harry Harlow in a section of his book under the subtitle The Development of the Personal Intelligences at about page 257 (as reported by my Kindle version). I should point out that, yes, Harlow, through his ethological study of rhesus monkeys, did help pour the scientific foundation upon which Bowlby’s theory of attachment rests. However, credit should also be given to Bowlby’s long-time collaborator, Mary Ainsworth, for adding the rebar to that foundation in the form of her anthropological studies in the villages of  Uganda. These studies allowed Ainsworth to develop the Strange Situation Assessment, still the gold standard for assessing attachment functioning in toddlers. One of Ainsworth’s students, Mary Main, went on to develop the Adult Attachment Interview, which remains the gold standard for assessing attachment functioning in adults.

Critics have argued that without the Harlow-Aisworth scientific foundation, Bowlby’s theory would have never gotten off the ground. I agree. However, Bowlby’s genius still remains his ability to bring all of the pieces together—ethology, psychoanalysis, developmental psychology, evolution theory, organismic systems theory—into a coherent whole, into a coherent system. As I have mentioned before, Bowlby’s work ushered in the age of “modern attachment theory” with its focus on neuropsychology and neurobiology. Allan Schore’s lifetime of work in the area of neurobiology shows clearly that early safe and secure attachment relationships are key to the proper development and functioning of right-brain systems, key to proper emotional regulation. As Gardner correctly observes, “If for some reason the bond [between mother and infant] is not permitted to form properly, or if it is broken abruptly and not soon repaired, profound difficulties are signaled for the child.” We do not need to look further than the work of Charlie Zeanah with Romanian orphans for evidence. It was through Dr. Zeanah’s work that Mary Main was able to add the fourth category of attachment functioning known as “disorganized attachment.”

Toddlers experiencing disorganized attachment are very hard to observe for they have no way to access organized and coherent patterns (i.e., cognitive maps) of navigating not only the world but also the world of social relations. I would suggest that “after-school restraint collapse” and disorganized attachment share much in common. They are both a form of dysregulation. As Gardner puts it, “[T]he absence of such a bond [of attachment] signals difficulty for an individual’s eventual ability to know other persons, to rear offspring, and to draw upon knowledge as he comes to know himself.” Personally, I still find it baffling that the decades of research, starting in the late 1960s, showing the importance of early safe and secure attachment relationships in the development of well-functioning minds, has had so little influence on our thinking here in the U.S. That something like “after-school restraint collapse” can exist outside reflection on attachment implications, baffles.

[4] – Wikipedia describes latchkey kids thus: “The term latchkey kid became commonplace in the 1970s and 1980s to describe members of Generation X who, according to a 2004 marketing study, ‘went through its all-important, formative years as one of the least-parented, least-nurtured generations in U.S. history.’ Latchkey kids were prevalent during this time, a result of increased divorce rates and increased maternal participation in the workforce at a time before childcare options outside the home were widely available.”

[5] – In her 1999 article Why Is Attachment in the Air?, Orbach does allow that it was probably shortsighted of emancipatory feminist thinkers to jettison Bowlby’s theory of attachment without first considering the potential blowback in terms of psychological and social damage to the developing infant/child.

[6] – Here’s the link to the article mentioned:

https://usafacts.org/articles/what-is-the-us-infant-mortality-rate/

[7] – Here’s an example of one of Dr. Means’ many YouTube interviews:

[8] – See my post entitled  Population Growth—A Systems Tale of Two Countries for more on this theme. Here’s the link:

https://bltblog.fhlfoundation.org/2024/08/11/population-growth-a-systems-tale-of-two-countries/

[9] – Back in 2010 our Foundation commissioned an article by systems scientist Dr. Gary Metcalf entitled John Bowlby: Rediscovering a Systems Scientist as as a way of bringing the organic systems theory aspects of Bowlby’s work to light. Contact the Foundation for a copy of this article.

[10] – Here’s the link to this article entitled Mysterious Link Between Alzheimer’s And Cancer May Finally Be Explained:

https://www.yahoo.com/news/mysterious-between-alzheimers-cancer-may-023342203.html

[11] Here’s the link to the Felicity Nelson article:

https://www.yahoo.com/news/study-500-000-medical-records-232312249.html