death


Last term I took a class called Wellness and Spirituality Through the Life Cycle. It was a good class. I learned a lot about how people in different spiritual traditions think about and cope with illness, death and dying. It was also depressing. Maybe it was that it came on the heels of Medical Family Therapy, which is another relentless 10-week focus on illness, death and dying. Ten weeks got me down, but 20 weeks had me hitting some pretty strong existential angst: My parents are getting older and are going to die one day. So am I. My grandfather is 91 and doing great but was recently diagnosed with Parkinson’s. Man, am I going to miss him one of these days.

One day in Wellness and Spirituality we had a guest lecturer–Jonathan Stemer, a transpersonal therapist from Looking Glass, the clinic where I now have an internship. He read us a poem from Mary Oliver and a quote from Rilke. Both of them hit home. It’s hard to describe exactly how, but something about the brutality of death and the possibility of an open mind and heart in the face of it. I try to live an open life, but I think that a stance of openness can be an illusion if not in sight of hardships like illness and death. It can be a game of frivolity or superiority – charming but weightless.

“When Death Comes” by Mary Oliver:

When death comes
like the hungry bear in autumn;
when death comes and takes all the bright coins from his purse to buy me, and snaps the purse shut;
when death comes
like the measles-pox;

when death comes
like an iceberg between the shoulder blades,

I want to step through the door full of curiosity, wondering:
what is it going to be like, that cottage of darkness?

And therefore I look upon everything
as a brotherhood and a sisterhood,
and I look upon time as no more than an idea,
and I consider eternity as another possibility,

and I think of each life as a flower, as common
as a field daisy, and as singular,

and each name a comfortable music in the mouth
tending as all music does, toward silence,

and each body a lion of courage, and something
precious to the earth.

When it’s over, I want to say: all my life
I was a bride married to amazement.
I was the bridegroom, taking the world into my arms.

When it is over, I don’t want to wonder
if I have made of my life something particular, and real.
I don’t want to find myself sighing and frightened,
or full of argument.

And here’s the Rilke quote:

“Have patience with everything that remains unsolved in your heart. Try to love the questions themselves, like locked rooms and like books written in a foreign language. Do not now look for the answers. They cannot now be given to you because you could not live them. It is a question of experiencing everything. At present you need to live the question. Perhaps you will gradually, without even noticing it, find yourself experiencing the answer, some distant day.”

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I’m learning about child abuse and neglect in my Child and Family Assessment class. Today I read about the ACE study, by the US Center for Disease Control. It is a huge study, with over 17,000 participants, where they gathered information about childhood abuse, neglect, and household dysfunction, and then proceeded to see what health outcomes and behaviors they could predict with that information. It turns out they can predict a lot. They’ve published 50 articles on the study and the research is ongoing–they are continuing to collect health information as the participants in the study age. I’ll present a few of their findings below. For more, see the ACE Study.

Here are some of their findings. I’ll paste in the definitions of the categories of adverse childhood experiences below. Strong correlations were found with the following:

  • alcoholism and alcohol abuse (4 or more categories of ACE meant 4-12 times increase)
  • chronic obstructive pulmonary disease (that is, lung disease)
  • depression (4 or more categories of ACE meant 4-12 times increase)
  • fetal death
  • health-related quality of life (way more inactivity, severe obesity, bone fractures)
  • illicit drug use
  • ischemic heart disease (IHD)
  • liver disease
  • risk for intimate partner violence
  • multiple sexual partners (4 or more categories of ACE correlated with 50 or more sexual partners)
  • sexually transmitted diseases (STDs) (4 or more categories of ACE meant 4-12 times increase)
  • smoking
  • suicide attempts (4 or more categories of ACE meant 4-12 times increase)
  • unintended pregnancies

Here are the kinds of abuse, neglect, and dysfunction they asked about, quoted from the site:

Abuse

Emotional Abuse:
Often or very often a parent or other adult in the household swore at you, insulted you, or put you down and/or sometimes, often or very often acted in a way that made you think that you might be physically hurt.

Physical Abuse:
Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at you and/or ever hit so hard that you had marks or were injured.

Sexual Abuse:
An adult or person at least 5 years older ever touched or fondled you in a sexual way, and/or had you touch their body in a sexual way, and/or attempted oral, anal, or vaginal intercourse with you and/or actually had oral, anal, or vaginal intercourse with you.

Neglect

Emotional Neglect1

Respondents were asked whether their family made them feel special, loved, and if their family was a source of strength, support, and protection. Emotional neglect was defined using scale scores that represent moderate to extreme exposure on the Emotional Neglect subscale of the Childhood Trauma Questionnaire (CTQ) short form.

Physical Neglect1

Respondents were asked whether there was enough to eat, if their parents drinking interfered with their care, if they ever wore dirty clothes, and if there was someone to take them to the doctor. Physical neglect was defined using scale scores that represent moderate to extreme exposure on the Physical Neglect subscale of the Childhood Trauma Questionnaire (CTQ) short form constituted physical neglect.

Household Dysfunction

Mother Treated Violently:
Your mother or stepmother was sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her and/or sometimes often, or very often kicked, bitten, hit with a fist, or hit with something hard, and/or ever repeatedly hit over at least a few minutes and/or ever threatened or hurt by a knife or gun.

Household Substance Abuse:
Lived with anyone who was a problem drinker or alcoholic and/or lived with anyone who used street drugs.

Household Mental Illness:
A household member was depressed or mentally ill and/or a household member attempted suicide.

Parental Separation or Divorce:
Parents were ever separated or divorced.

Incarcerated Household Member:
A household member went to prison.

There are two official DSM diagnoses for eating disorders, with two variations each. This gives us four options: Anorexia Nervosa, Restricting Type; Anorexia Nervosa, Binge Eating/Purging Type; Bulimia Nervosa, Purging Type; Bulimia Nervosa, Nonpurging Type.

This is are direct direct quotes from the DSM-IV-TR. “Postmenarcheal” means after the onset of the menstrual cycle. In addition to Anorexia Nervosa and Bulimia Nervosa, there is a category with no diagnostic criteria called Eating Disorder Not Otherwise Specified that clinician can give to someone “for disorders of eating that do not meet the criteria for any specific Eating Disorder.” People diagnosed with EDNOS are even more likely to die from their conditions than those in AN or BN.

Diagnostic criteria for 307.1 Anorexia Nervosa

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during a period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Specify type:

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Diagnostic criteria for 307.51 Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxative, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

“I think the best function of funerals is served if it brings relatives and friends into the best possible functional contact with the harsh fact of death and with each other in this time of high emotionality. I believe that funerals were probably more effective when people died at home with the family present, and when the family and friends made the coffin and did the burial themselves. Society no longer permits this, but there are ways to bring about a reasonable level of contact with the dead body and the survivors.”

Murray Bowen, in Walsh & McGoldrick’s Living Beyond Loss: Death in the Family

As I was leaving campus I saw an earthworm crossing the sidewalk. I usually rescue worms that are obviously alive and in danger but tonight I did not. It was a big one, with a lot of energy, cruising along pretty fast. It was already more than halfway across, and I was the only one on the sidewalk. I considered encouraging it to move more directly toward the edge–it was moving at an angle–but it might curl up and stop moving if I messed with it and I figured it only needed a minute to make it across at it’s current trajectory. And if I went to the effort of squatting, I might as well just move it to safety, but I didn’t see any little sticks handy to move it with and those guys can be hard to pick up with the fingers… Anyway, I didn’t intervene. Though it might not  sound like it, this took just a few seconds.

I was about five feet past the worm when two young women, deep in a conversation about not overdressing for a party they were planning to attend, crossed the street and walked past me, towards the worm. I considered saying something like “Look out for the worm,” but I did not. It felt awkward when I thought of saying it. I thought “What are the chances that one of them will step on the worm anyway?” I did turn around to see, though, and one of the young women stepped right on the worm. I went back and checked. Maybe there had been a stick nearby. No. The worm’s guts were all hanging out and half of it was writhing around. It looked pretty painful. Now I took the time to find a stick and move it to the side. Sometimes worms can survive this kind of thing, right? It didn’t look survivable.

This morning, as I was walking to the bus stop, I saw a family of ducks trying to cross the road. The traffic at that spot on Franklin Boulevard, right before it crosses the Willamette River, is  heavy. It’s the main drag into Springfield from Eugene and the I-5. Prospects were not good for these ducks. It was a mother and seven or eight tiny, fluffy, cute ducklings. I love baby ducks. They are about my favorite animal. They were already off the curb, committed. What could I do? I stopped traffic and herded them across. It took a while, but the motorists seemed supportive. One old hippy  gave me a thumbs-up. When they were across and the traffic started to whiz by again, I realized that the ducks were still screwed. The mother hopped up the curb to the bank, but the babies couldn’t make it. They aren’t very good jumpers. So I decided to help them out again. When they saw me walking towards them, though, they ran away, directly onto the storm grate. It turns out that baby ducks are the perfect size to fit through a storm grate. Immediately, several of them are caught in the grate and I rush over and start pulling them out and setting them on the curb as fast as I can but one of them falls through. It was only about four feet down, but I couldn’t reach through the grate and I couldn’t lift the grate up. It was either locked somehow or super heavy. That little duckling was so pathetic down there, peeping and swimming around in the muck. It was distressing. The mother was already heading down the hill with the others trailing behind.

A homeless woman panhandling on the next corner asked if I’d stopped traffic for those ducks. She seemed to approve. She seemed nice. I wondered later if she’d been thinking something like, “Wow, a guy who helps ducks. Surely he’ll give me a buck.” I did not give her any money.

I called the Springfield Public Works Department and left a message about the duckling and a couple hours later got a message back: “Hi Nathen, this is Linda at the SPWD. We did send over our first truck driver and he checked all of the catch basins, east and westbound, north and south side, at the bridge, and we did not find a duck, but the water is moving pretty fast through there, so either it got swept away or it safely got out. We did not find a duck. Thanks for the call.”

I was a little suspicious, because the water in the drain had hardly been moving at all, and there seemed to be little tunnels down there that the duckling could swim through, so they wouldn’t necessarily have seen it. So, on my way home, I listened at the grate, but no peeping.

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