Oxford University Press's Blog, page 175

Music and spirituality at the end of life

Music and spirituality are two mediums frequently – almost ubiquitously – partnered in cultures around the world with the intention of enhancing engagement with the divine. Spiritual practices are infused with music to intensify the transpersonal components of worship, meditation, and ritual. Correspondingly, musical encounters are infused with spiritually-based beliefs and practices to provide individuals connections with themselves and others in uniquely powerful ways.

For many, this easy, reciprocal flow from music to spirituality may come as no surprise: both are malleable mediums responsive to the people engaging with them and the settings in which they are engaged. For instance, Amazing Grace performed at a funeral in a church with a large congregation might be led with a louder volume, increased pressure, and heightened resonance to match the congregation’s energy as they worship through song. In contrast, Amazing Grace performed bedside in a hospital room with a patient and caregivers might embody quieter, more prayerful qualities intending to comfortingly hold the patient in their depleted physical state and engender intimate musical sharing.

As music and spirituality intertwine, their boundaries become increasingly fluid to the point that distinguishing between one and the other becomes trivial. To be spiritual is to be musical, and to be musical is to be spiritual.

A similar malleability is also present in individuals’ health journeys. Objective characteristics of health – such as symptom acuity/chronicity; treatment dosage and frequency; and curative versus palliative outcomes – are subjectively experienced in response to the individual’s values, morals, and disease trajectory. For instance, one person’s 6 out of 10 pain is their daily baseline and thus easily managed, while another’s 6 out of 10 pain is breakthrough and requires treatment. Similarly, one person may prioritize the improved quality of life offered by palliative care while another may prioritize the potential increased longevity offered by curative treatments.

These dynamic, emergent qualities of music, spirituality, and health are a result of each being culturally situated phenomena. That is, the manner in which music, spirituality, and health are conceptualized and engaged with is directly informed by the distinct cultures in which they manifest. This leads to a fraught but important question: If music, spirituality, and health are each unto themselves complex phenomena derived from cultural factors, how do all three interact when they intersect in a singular encounter?

Board-certified music therapists frequently navigate this encounter in hospice. Hospice is a philosophy of care that prioritizes quality of life with six months or less to live, putting critical health issues at the forefront with limited time to facilitate resolution and closure. At such a juncture, spirituality can be a critical resource for patients and families who are simultaneously managing in the moment and preparing for the future. The type of resource spirituality can become (e.g., comfort in ritual, strength from scripture or peace through prayer/meditation/worship) is determined by the specific faith traditions of the patient – not just an identified denomination but the explicit experiences patients engaged in as part of their spiritual practice.

Music therapists assess those faith traditions for each patient and, coupled with a similar assessment of patients’ music traditions, craft music experiences that help patients become aware of and engage with their spiritually-based resources. These culturally informed clinical music processes interweave music, spirituality, and health in a way that affords patients agency in dictating the circumstances of their death. Yet, contemporary discussions in the music therapy literature have tended to frame spirituality from such a broad and generic stance that it becomes difficult for music therapists to locate spiritually-based resources in patients.

To address this limitation, my co-author (Cathleen Flynn) and I recently authored a paper that explored a specific culturally informed music, spiritual, and health intersection: music therapy for Christian patients and caregivers during imminent death. Using this intersection as a foundation, we developed a theoretical model positioning music therapy as a psychospiritual ministry providing patients and caregivers access to a faith-based resource – the Holy Spirit – that assists with transcendence as end-of-life transitions neared.

Transcendence, a difficult concept to lock down, is a movement beyond the typical, readily accessible experiences that define our day-to-day to experience the self and other in new ways that push beyond our known thresholds. For Christian patients who are imminently dying, that transcendence is vertical, an upward trajectory that moves them closer to an integration with the divine as they move beyond the corporeal. For Christian caregivers, that transcendence is horizontal, an outward trajectory that moves them closer to mortal support structures that assist in their transition to bereavement. The Holy Spirit, an intermediary between the mortal and divine, is the faith-based avenue through which these different but concomitant transcendences occur. From this vantage point, the music therapist assumes a ministerial role, constructing dynamic music experiences that facilitate interactions with the Holy Spirit promoting patient and caregiver transcendence.

Such explicit framing is ethically fraught. First, we do not argue that adopting a Christian lens is the “only” way or the “correct” way for music therapy to be practiced in hospice; rather, we introduce this theoretical model as a broad template for conducting spiritual assessments of patients from diverse traditions and beliefs. Second, this is a person-centered model wherein any implementation of Christian theology into music therapy processes is cued by the patient rather than introduced by the music therapist; this is an essential aspect as it avoids the perception that music therapists might leverage privilege to proselytize to patients. Third, there are numerous avenues for ethical and effective clinical support of Christian patients and families at the end of life, and this model is not meant to be a linear prescription; rather, it is an exploratory avenue that opens a multitude of additional doorways for providing psychospiritual care.

As the baby boomer generation continues to advance in age, it will be increasingly important that healthcare systems are well positioned to provide comprehensive end-of-life care addressing mind, body, and spirit as equal partners in whole-person health. Music and spirituality continue to be important day-to-day aspects for many people, and exploring diverse permutations of music, spirituality, and health intersections can be an important contribution to this pursuit of the good death.

Featured Image Credit: “selective focus photo of brown guitar on white pillow” by Kari Shea. Royalty free via Unsplash.

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Why more democracy isn’t better democracy

Democracy is necessary for a free and just society. It is tempting to conclude that democracy is such a crucial social good that there could never be too much of it. It seems that when it comes to democracy, the more the better.

Yet it is possible to have too much democracy. This is not an anti-democratic contention. Holding that democracy is a crucial good is consistent with denying that more is always better. Democracy’s flourishing requires that we avoid overdoing it. In other words, when democracy is overdone, democracy suffers and politics devolves. Let me explain.

Consider a case in which we readily admit the possibility of having too much of a good thing:  cheesecake. However satisfying that first bite may be, the tenth is far less so. Moreover, there is a point at which cheesecake becomes positively displeasing. Hence we say that cheesecake is subject to diminishing utility: with every bite, the value of the next diminishes. We must not be excessive in consuming cheesecake, or else it loses its value. It’s good alright, but only in the right portion.

No one would claim that that democracy and cheesecakes are alike in this respect. So if there’s such a thing as having too much democracy, there must be another way in which a good can be overdone.

I once knew someone who decided to pursue optimal physical fitness. Apart from working and sleeping, she devoted her life to her workouts. After several months of intense exercise, she was in exceptional shape. However, along the way she lost her friends and allowed all of her other interests—travel, opera, and antiques—to wither. She allowed one good thing to crowd out all the other good things in her life.

To this day I wonder what the point could have been. One reason why being fit is good is that it enables us to engage in valuable activities other than working out, such as going to concerts with friends. But she achieved fitness in a way that left her friendless. She achieved fitness at the expense of the things that being fit is good for.

Democracy, like fitness, has a point. No matter what one might believe about democracy’s intrinsic value, what makes it such an important social good is that it enables goods of other kinds to flourish. When these other goods are crowded out of our collective lives, democracy becomes pathological.

Consider that democracy is not only a form of constitutional representative government; it is more fundamentally a system of collective self-government among social equals. When equals govern themselves, you can count on persistent, and often severe, disagreement about politics. As these disagreements are commonly high-stakes, there is an ethos that democratic citizens must embody. This enables citizens to sustain their respect for each other’s equality amidst ongoing political disputes. As citizens lose the capacity to respect each other’s equality, democracy devolves into a cold civil war by which factions seek simply to rule.

When there’s too much democracy, the travails of current politics penetrate the whole of social life. Well-documented trends suggest that in the United States and elsewhere, rival partisans do not merely divide over politics; they also live in different neighborhoods, shop at different stores, drive different vehicles, follow different sports, consume different entertainment, worship at different churches, and do different kinds of jobs. Consider: Walmart or Target? Hybrid or pickup? Camo tee or yoga pants? Starbucks or Dunkin’? NASCAR or NBA? This partisan clustering of social life means that our everyday encounters are increasingly likely to place us in contact only with others who are politically much like ourselves. The trouble is that as the horizon of social experience condenses around our co-partisans, we become more extreme in our commitments and grow more suspicious of, and more hostile towards those who we perceive to be politically different. Eventually we come to see everything as an expression of our political identities, and our political rivals begin to look increasingly alien and even threatening. Thus we lose the capacity to see them as our social equals, and democracy devolves into a cold civil war.

Commentators from across the spectrum lament the polarized state of democracy. Polarization is indeed regrettable. However, it has its root in the infiltration of politics into the entirety of social life. Although it might be helpful to “reach across the aisle” and foster bipartisanship, the real trouble for democracy lies in the fact that rival partisans live wholly different lives. To restore democracy, we need to recapture the shared social, but non-political, goods that our overenthusiastic democratic pursuits have crowded out of collective life. That we struggle to envision share social goods that are nevertheless non-political is a symptom of our tendency to overdo democratic politics.

Image credit:“Torn,” by Sergio Vassio Photography, CC 2.0, via Flickr

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The long trauma of revenge porn

In case you haven’t been paying attention, the intersection of sexual violence and technology has become an invisible tidal wave heading for the shores of our smart phones. Revenge porn – academically known as image-based abuse, non-consensual pornography, or the non-consensual sharing of intimate images – is one of a host of cyber-sexual violations clustered as technology-based sexual violence.  The most popular cases in the United States press show how wide the epidemic has spread. Celebrity scandals like the one involving Blac Chyna, Congressional hearings on its presence in the United States Military, and a recent filing with the United States Supreme Court about the dating app, Grindr, and its responsibility in the harassment of an man whose ex-boyfriend impersonated him and sent over 1,400 Grindr (as many as 23 a day over 10 months) users to his house and work for violent, and forced, sex, are just a few examples.

Beyond spiteful ex-lovers and predatory peeping toms, revenge porn includes hacking hard drives, under-skirting, and the use of deep fakes where a victim’ face is overlaid onto someone engaging in sexual acts. The seamless nature of this technology can make it hard for victims to convince observers it is not them in the video, which can have lasting consequences on victim’s lives and their mental health.

Image based sexual abuse is a form of cyber-harassment or bullying that involves publicly posting an intimate image that the victim has not consented to have shared. Scenarios include when victims consent to sharing an image or video with a single person (often an intimate partner) that is then shared by the recipient without consent, having images hacked from personal storage then posted on porn sites, or the sharing of images that were recorded without the victim’s consent at all.  Sometimes the victim’s personal information is shared along with these images, leading to ongoing harassment far beyond the public display of the image. Other times the victim is unaware of the crime for months or years until discovered on the dark web or a porn site.

Revenge porn is widespread throughout the globe. In 2017, the Cyber Civil Rights Initiative shared data from a US survey that showed 1 in 8 adults are victims of non-consensual image sharing and one in 20 admit to sharing intimate images without consent. Other researchers found similar rates in a nationwide sample in Australia, where citing one in 10 had been victimized online, with more than half of those reporting the incident occurring in the last year.  Women are victimized in this crime more than men, with LGBTQ communities and women of color experiencing the highest rates.

Sexual trauma in face to face violence has decades of research showing a cluster of symptoms that most survivors have in common, including confusion, changes in sleep and eating patterns, nightmares, and a heightened startle response in the short term that will prevent them from engaging socially. Longer term symptoms include post-traumatic stress disorder (PTSD), depression, and anxiety. Are these symptoms the same for victims of image based sexual abuse? We don’t really know for sure.

The mental health community is just starting to understand the short and long-term outcomes of being victimized online. Most studies have shown that survivors victimized online have significantly worse “mental health outcomes” and “somatic symptoms” than those who have never been victimized online.  One researcher interviewed 18 women in Canada who were sexually victimized online and discovered PTSD, anxiety, depression, suicidal thoughts, and trust concerns. Research by the Cyber Civil Rights Initiative uncovered a prevalence of suicidal thoughts while other research has found that victims of non-consensual image sharing often experience debilitating levels of shame and humiliation along with reduced self-esteem.

These reports indicate revenge porn appears to have the same post-assault symptoms as “face to face” sexual violence. However, what is drastically different in online abuse is the duration the violation. With the exception of domestic violence, kidnapping, and torture, ‘face to face’ sexual assault commonly takes place in hours of time whereas revenge porn often entails the ongoing  re-victimization as images spread across the digital landscape to new audiences and are viewed multiple time by the same audiences for months or even years. Many victims report having the image taken down off of one online platform, only to have it reappear on another one. For some survivors of revenge porn, they never succeed at removing their image and have to endure the long term effects of knowing someone is looking at their naked image at any moment in the day. The length of time that a person endures this kind of trauma has a significant effect on how mental health symptoms like PTSD will take hold, suggesting revenge porn victims might also have longer trauma recovery periods than survivors of what therapists call single incident trauma. But this is all speculative, more research needs to be done to show these effects.

A glimmer of hope is that the legal world is beginning to take note and pass legislation to protect the public. Australia now has a national office dedicated to fighting cyber-crimes, specifically revenge porn. Recently the US military has updated the Uniform Code of Military Justice to prevent revenge porn while many states have begun passing varying forms of legislation. The bad news is that more laws are not translating into more convictions. One reason is victim-blaming attitudes by police.  Another is inconsistent laws across jurisdictions, highlighted by the recent debate on a New York law, which advocates say is deeply flawed.  The outcome of cases like Herrick V. Grindr will also determine if digital and social media companies are legally accountable for crimes committed by users on their platforms.

What can we do in the meantime? One is to educate ourselves.  Talk to our friends, students, therapists, and professors about these types of crimes. Another is to support one another in efforts to prevent this nature of victimization from spreading. If someone tells you they have been victimized in this way, believe them, listen to them, and help them feel safe in whatever way that means for them (both digitally and privately in their community). Nobody has to go it along.

Together we can all push back against the tide of image based sexual abuse and digital victimization, and hopefully prevent the scurrilous mental health impacts that come with it.

Featured image via unsplash

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Looking back on 10 years of global road safety

According to the World Health Organization there were 1.35 million road traffic deaths globally in 2016 and between 20 and 50 million more people suffered non-fatal injuries and/or disabilities.

Most of these collisions occurred in low- and middle-income countries and involved pedestrians, cyclists, and motorcyclists. In addition, road traffic collisions are the leading killer of those between 15 and 29 years of age.

Despite some progress being made globally, and in some regions and countries, road traffic fatality rates remain unacceptably high.

The issue of road safety came to the fore when the 1999 World Disaster Report showed collisions as the leading cause of death for humanitarian workers. Despite this, there has been significant road safety progress over the last decade.

2009 was an important year. It was the year that the first Global Status Report on Road Safety was published, revealing the extent of the problem. The first ministerial meeting on road safety was hosted by the Russian government which called for a Decade of Action for Road Safety (2011–2020); and Bloomberg Philanthropies announced a US$125 million investment to implement good practices in 10 low- and middle-income countries.

A Global Plan for the Decade of Action was develop and launched in 2011 encouraging countries to implement good practices in five pillars: road safety management, safer roads and mobility, safer vehicles, safer road users, and post-crash response.

In 2015 the issue of road safety was raised to the highest level through the inclusion of two Sustainable Development Goal (SDG) targets (3.6 and 11.2) on road safety. Target 3.6, with an endpoint of 2020, proposes a 50% reduction of road traffic deaths and injuries from the baseline of around 1.25 million.

The Brazilian government hosted the second ministerial meeting on road safety, the outcome of which called for the development of global voluntary targets for road safety risk factors and service delivery.

A UN Road Safety Trust Fund was also set up and the first US$1 million was provided to implement five pilot projects in 2018. These projects included:

advancing street design in Ethiopia,improving data collection in Cote d’Ivoire and Senegal,strengthening legal frameworks in Arab countries,reducing speeds in the Philippines, andbuilding capacity for improved urban planning and sustainable transportation to keep children safer in Paraguay, the Philippines, and South Africa.

The 4th Global Status Report, published in 2018, revealed little change in the 10 years since 2009, however. Reasons cited include rapid population growth, urbanisation, and motorisation in many countries coupled with incomplete data, inadequate enforcement, inferior safety standards for vehicles and roads, and poor road-user behaviour, such as driving under the influence, speeding, and not wearing helmets or seat belts.

However, some countries have made significant progress. Thailand, for instance, has addressed the discrepancies between its reported road safety data and the estimates published by the World Health Organization through a process of triangulation of three data sources.

Sweden is an example many nations aspire to copy. It has seen steady reductions in both fatal and non-fatal road traffic crashes since the country launched its “safe systems” approach in 1994.  The Safe System approach focuses on how the components of the road transport system can work together to prevent fatalities and injuries.

There is still an urgent need to do more as the numbers have plateaued but have not yet begun to show a downward trend.

To save more lives a stronger emphasis on building capacity at the national level is essential, as experience from donor-funded initiatives reveals that money alone does not help if there are no local adequately trained road safety practitioners. Dedicated road safety research programmes such the Global Road Safety Leadership Course, run by the Global Road Safety Partnership and Johns Hopkins Bloomberg School of Public Health, aim to build leadership capacity so that people can understand, design, and implement road safety programmes while advocating for policy change.

There is increasing interest in the role of co-design and community-based participatory research in road safety, which involves communities rather than just governments and research institutions working in silos. One example is the work done by the NGO Amend through the School Area Road Safety Assessment and Improvement programme in Tanzania. This involves the assessment of schools zones, identification of specific measures that would improve road safety, and the implementation of those measures with the engagement and participation of the community and local authorities.

The corporate sector has become increasingly interested in road safety initiatives: FedEx is one such company that expects only the highest road safety from its entire staff while also supporting road safety initiatives around the world.

Solid evidence of what works in low-income countries (including sustainable transportation and improved urban planning options), using robust research methodologies, is urgently required so that these can be scaled up and replicated.

Countries and practitioners should be empowered to monitor their road safety deaths and injuries and rigorously evaluate their programmes. Fondation Botnar, for example, has built into its grant mechanisms an expectation of robust monitoring and evaluation using digital health mechanisms where appropriate.

Finally, solid trauma services – from extrication of occupants at the crash site to justice for victims – should be better supported and implemented.

For a reduction in road traffic deaths and injuries to happen in the next decade, countries need to implement a systems approach to road safety, build capacity, and engage end users. They should also scale up their enforcement activities, design smarter roads, sell safer vehicles, and deliver powerful social marketing campaigns to raise awareness among all road users.

Featured image credit: “Bangkok, Thailand” Copyright of M. Peden. Used with permission.

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Ten Facts about World Peace

The United Nations’ International Day of Peace is celebrated on 21 September each year, marking efforts to bring the world closer to a state of harmony and further away from violence. Here are some surprising facts about peace and the quest to achieve it:

1. Peace is more common than we think.

Through the course of human history, most societies have enjoyed peace, most of the time. In fact, some societies have avoided war altogether or for very long periods. One study found that a tenth of societies never experienced war and over half experienced it only once a generation.

2. In the twenty-first century, most regions of the world are more peaceful than they have been for generations – if not ever.

Humans alive today are less likely to die as a result of wars or atrocities than their parents or grandparents. War in East Asia is at its lowest point in centuries and has been for nearly three decades. War is almost extinct in the Americas, Caribbean, and western Europe. It is now uncommon in eastern Europe, southern African and increasingly in coastal west Africa.

3. The search for peace is as old as war itself.

For as long as there has been war, there have been people trying to find ways of resolving disputes without it. The very first human story written down, the epic of Gilgamesh (c. 1500-2000 BCE), recounts how this King of Uruk learns that war and conquest cannot give him immortality. Gilgamesh finds meaning in life by becoming a wise and just king and abandoning the wanton violence of his past.

4. Aggressive war was prohibited by international law in 1945.

Governments have a legal obligation to not use force against others. This obligation is written into the Charter of the United Nations. There are only two exceptions: self-defence and operations authorised by the UN Security Council. The crime of aggression is now recognized by the International Criminal Court, which means that political leaders might one day be prosecuted for launching wars.

5. Gender equality makes states and societies more peaceful.

Gender-equal societies are far more peaceful than patriarchal societies. Studies have repeatedly demonstrated a connection between gender equality and peace. More gender equal societies are less likely to wage aggressive wars, less likely to experience civil wars, and more likely to support international institutions. Peace processes that include women as equal partners are more likely to deliver sustained peace. Gender equal societies tend to have better relations with their neighbours.

6. Economics matters.

Peace and economic development go hand in hand, as does war and economic decline. As a basic rule of thumb, societies become less prone to experiencing civil war the wealthier they become. That is not to say that middle income countries never experience civil war, just that it is much rarer. There is also a connection between the level of economic inequality and a society’s risk of mass atrocities. War on the other hand tends to have a significant negative impact on economic development. It is no coincidence that the greatest declines in war have come in places experiencing significant economic improvements.

7. UN peacekeeping works.

A large body of academic work demonstrates that UN peacekeeping operations help prevent wars, shorten wars, limit civilian suffering, and reduce the likelihood of war recurring. It also shows that quantity has a quality all of its own. The greater the number of peacekeepers deployed, the greater these positive effects tend to be.

8. We spend much more on war than we do on peace.

Despite clear evidence that conflict prevention, peacekeeping, humanitarian action, and peacebuilding have positive impacts, these activities are all under-resourced. Global spending on arms is approximately $1.8 trillion. It is estimated that annual cost of war is around $1trillion. By contrast, the entire UN system – its peacekeeping operations, humanitarian programs, development work and much else, costs around $50billion a year – a tiny fraction of what is spent and lost on war. The result is that peacekeeping missions often lack the troops they need, humanitarian aid is rarely sufficiently funded, and basic functions like mediation lack guaranteed funding.

It is estimated that annual cost of war is around $1trillion. By contrast, the entire UN system – its peacekeeping operations, humanitarian programs, development work and much else, costs around $50billion a year – a tiny fraction of what is spent and lost on war.

9. The Christmas truce wasn’t limited to 1914.

There was one in 1915 too. Despite the best efforts of commanders on both sides, on Christmas Day 1915 soldiers of the 15th Battalion Royal Welch Fusiliers left their trenches to exchange gifts and play football with German soldiers. Their commanding General demanded they stop and threatened to court-martial all involved. British artillery fired warning shots. But when the General left the frontline, the soldiers went back into no-man’s land to talk and sing together.

10. 21 September marks the International Day of Peace.

The Peace One Day initiative, launched twenty years ago at London’s Global Theatre, is a campaign to make The International Day of Peace, 21 September, a day that is truly without war. If peace can be achieved in some places where war once reigned, as in Western Europe for example, then there is no reason why it cannot be achieved in all places. One day of peace may not be much. But it is a start that would show that world peace is possible.

Feature image: International Day of Peace, public domain via Flickr

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Why hurricanes are deadly for older people

Meteorologists have pinpointed 10 September as the peak of hurricane season. September is the most active month of the year for Atlantic hurricane season, and 2019 is no exception. In early September, Dorian devastated the Bahamas, and wreaked havoc on the southeastern United States. Hurricane Maria battered Puerto Rico in September 2017, just weeks after Harvey and Irma touched town, while other late-summer storms – most notoriously Katrina in 2005 – have left death and destruction in their paths. Climate experts say rising temperatures will increase the risk of more intense storms. Temperature increases also may hasten melting glaciers and ice caps, and rising sea levels – making coastal flooding more severe when storms hit shore.

Hurricanes have far reaching impacts for all people, yet these impacts are particularly devastating for older people, especially those already suffering from poor health and financial insecurity. Older people make up 12% of the overall U.S. population, yet they made up two-thirds of the estimated 1,800 people who died in Katrina, and more than half of the 117 who succumbed to Hurricane Sandy.

What makes older people vulnerable? It’s not simply the frailty of old age that killed these victims; most deaths were a consequence of environmental and social factors that the victims could not overcome. In the case of Hurricane Katrina, two-thirds of older victims either drowned or dead from illness or injuries brought about from being trapped in their houses, surrounded by water. The remaining one-third fell to injuries, infections, and other health conditions worsened by the difficult evacuation process. The physical wear-and-tear of evacuation can hasten the fatal effects of pre-existing health conditions like heart disease or weakened immune systems. Some frail older people seek medical care in local hospitals that have lost power and can’t provide life-sustaining treatments like oxygen. The most tragic case occurred during 2017’s Hurricane Irma, when twelve Florida nursing home residents, ages 71 to 99, died of heat-related causes after the facility’s air conditioning failed.

Some disaster experts say that deaths occur following hurricanes and floods because local residents fail to evacuate promptly. Yet for older people, this is less a matter of willful defiance and more a matter of an inability to comply with evacuation orders. Poor and socially isolated older people are least capable of evacuating. Some stay put because they have nowhere to go, and no one to help them move. People with cognitive impairments may not understand how sever the risk is, and may require help in making timely decisions. The notion of relocating to an area where one has no social ties and has to start over again is also difficult. Some lack the social support to help them safely prepare for the storm. The first North Carolina fatality of Dorian this month was an 85-year-old man who fell from a ladder while trying to prepare for the storm.

Others don’t want to abandon the few meager possessions they have, a legitimate concern for destitute older people. For socially isolated elders whose main source of emotional support is a pet, evacuation to a shelter may mean a separation (often permanent) from one’s faithful friend, as shelters are not dog- and cat-friendly. Some one-third of older pet owners in the Miami-Dade area needed assistance evacuating with their pets. Older people often live on the city’s outskirts, considerable distances for the area’s few pet-friendly shelters. These obstacles in traveling to the pet-friendly shelters were a major factor in their failure to evacuate.

For elderly people who decide to stay in their communities, services and supports may not be readily available. During a major disaster, local medical resources like hospitals and EMT services may be overwhelmed and out-of-state assistance like disaster relief teams may face obstacles reaching remote, isolated, or frightened older people. Pharmacies often are closed or without power and older people may lack the transportation, money, or assistance needed to obtain additional medications. In some cases, support services provide only a short-term fix. In the case of Katrina, the city of New Orleans received federal and state money that paid for buses, trucks, and trains to relocate local residences to government-funded shelters. Yet the stress of the move and uncertainty about what the future would hold after leaving the shelter kept many frail and socially isolated adults in their unsafe homes and communities.

Life also doesn’t necessarily get easier for elderly people after the storms pass. Older people are more likely to have been displaced after storms. They experience high levels of community and storm damage that prevents them from returning to their houses. If older people are to withstand the escalating number of September storms projected to strike in the coming years they need, pet-friendly shelters, family and community support, and safe housing, health care, and transportation.

Photo by  David Mark  from  Pixabay.

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The ‘What If’ moments of modern Britain

We often talk about there being days that “changed history”; modern British history has had its fair share of them. But what about the days that looked as though they would – but didn’t? Which days once felt like they would change everything but, with the benefit of hindsight, now seem false-starts? Here are three contenders.

The 26th of June 1984. The day Britain nearly turned to Europe.

Two Tribes by Frankie Goes to Hollywood was No. 1 and the first edition of Crimewatch had just been broadcast. In Fontainebleau, 40km south of Paris, and after four years of very public and often nasty arguments, a European Council meeting ended with an agreement having finally been reached on the British budget rebate, signaling a fresh start for Europe’s perennially awkward partner. For a while, Britain looked ready to grasp the opportunity being offered; with the budget issue settled, the European Commission sought to build political momentum behind a new effort to establish a single market for goods, services and people. Margaret Thatcher was an enthusiast, even showing herself willing to sacrifice Britain’s veto at the Council of Ministers and endorse the use of qualified majority voting to ensure it would work. For the first time since it had joined in January 1973, Britain was working towards more integration with Europe rather than less. But, in the end, it all went wrong. The European Commission and its President, Jacques Delors, argued that the new single market must have a “social dimension” and, separately, after a decade-long hiatus, European leaders once again began to talk about a single currency. Margaret Thatcher was singularly unimpressed and used her 1988 Bruges lecture to set out her Eurosceptic stall. “We have not rolled-back the frontiers of the state in Britain, only to see them reimposed at European level”. Pro-European Conservative MPs were left high-and-dry and, within a few years, Margaret Thatcher’s burst of Euro-enthusiasm was all but forgotten.

The 6th of January 1996. The day Blair turned left

At a time when he was already odds-on to win the next general election, Tony Blair found himself delivering a high-profile speech on “stakeholding” in Singapore. The speech was unexpectedly radical, right down to the Corbynesque pledge to create a future Britain “for the many, not just the few”. Blair argued that the British economy was being disfigured by an ideology that viewed firms as “mere vehicles for the capital market to be traded, bought and sold as a commodity”, which discouraged long-term investment, good relationships with workers, productivity, and trust. Blair was light on the details of his stakeholding alternative. But this was, nevertheless, an important moment. New Labour might, after all, be about more than a variant on the tried-and-tested social democratic theme of taxing, spending and redistributing the money made by firms. Blair, it seemed, might be willing to remake capitalism. But the moment passed. Stung by criticism that stakeholding was all about appeasing the trade unions, Blair took fright and stopped talking about economics in order to focus on the much-safer electoral ground of education and the NHS.

The 31st of August 1997. The day Princess Diana died 

The death of Diana really was one of those moments. Everyone remembers where they were and nobody expected what happened next: public outpourings of grief; the “People’s Princess” soundbite from Blair that resonated across the country; fury at the paparazzi; and “what do they think they are doing?” disappointment and anger with the Royal Family and their apparent lack of interest in or care about Diana’s death. Was there a Republican revolution in the air? For a few short days until, belatedly, the Union Flag was lowered to half-mast at Buckingham Palace, the question did not seem silly. Today, Diana’s fame stands but there are few traces of the anti-monarchist attitude left. Nine photographers who had been trailing Diana’s car through central Paris were charged with manslaughter but subsequently released. Despite the public outcry at what happened, there was no new press regulation. Indeed, two decades on, it is difficult to see much difference in the treatment meted out to Diana with that experienced by Kate Middleton and Meghan Markle. As for the Royal Family, it weathered the reputational damage created by Diana’s death remarkably well. Criticism over Prince Charles’ premarital affair ground to a halt and republicanism, never more than a minority taste, remained on the periphery.

History does sometimes turn on a day. The general election on 3rd May 1979 that ushered Margaret Thatcher to power. 9/11. The collapse of the Northern Rock bank. The publication, in the Daily Telegraph, of MP’s expenses in 2009. But, as these ‘could-have-been’ moments show, history sometimes looks to turn only to then turn back.

Featured image credit: ‘Union Jack Flag’by Andrik Langfield. Public domain via Unsplash.

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Fears of a Latino invasion: demographic panic then and now

How are Donald Trump’s racist tweets about “rat-infested” Baltimore, his tacit endorsement of chants of “send her home” about representative Ilhan Omar at his rallies, and the mass shooting in El Paso, TX, targeting Latinos by a gunman concerned about a Mexican “invasion” of the United States connected? The idea of an immigrant invasion that would swamp the Anglo-Saxon population was originally popularized by Madison Grant (1865-1937), an early 20th-century eugenicist and conservationist, who was a proponent of immigration restrictions and legally mandated racial segregation to preserve white racial purity. Grant wrote one of the most widely influential texts of scientific racism produced in the United States, which was translated into multiple languages and embraced by Adolph Hitler and the Nazis in Germany, among others. At the time, non-white intellectuals from different parts of the Americas—such as the African-American W. E. B. DuBois and Mexican philosopher Jose Vasconcelos—challenged Grant’s ideas because of their dire implications for people of color inside and outside the United States.

In his best-selling The Passing of the Great Race or The Racial Basis of European History (first published in 1916), Grant argued that dominance of the supposedly superior Nordic race in the United States was being threatened by nonwhite immigration and mixture with inferior races. Grant’s ideas about Anglo-Saxon racial superiority and the need to preserve strict boundaries between different racial groups helped shape public policy in the United States, including immigration and domestic racial segregation. They paved the way for restrictions on immigration to the United States by Southern and Eastern Europeans and for total bans on Asian immigration, such as those enacted in the national origin quotas of the Immigration Act of 1924, which was the country’s first widely restrictive immigration law. The main purpose of the 1924 Immigration Act was to try to preserve an Anglo-Saxon white majority in the U.S. population. According to the office of the U.S. Historian: “In all of its parts, the most basic purpose of the 1924 Immigration Act was to preserve the ideal of U.S. homogeneity.”

Grant also championed anti-miscegenation laws that helped codify the “one-drop rule” and Jim Crow racial segregation, such as the Virginia Racial Integrity Act of 1924, which became a model for other racial segregation statutes in the South. The aim of the Racial Integrity Act was to demarcate the boundaries of whiteness at the state level. It required that a person’s race to be recorded on birth and marriage certificates, prohibited interracial marriage, and defined who counted as a white person. Such anti-miscegenation statutes initially banned unions between whites and African-Americans, but were expanded to all nonwhites, including Native Americans in the case of Virginia. The Racial Integrity Act remained in force until 1967, when it was overturned by the U.S. Supreme Court’s decision in Loving v. Virginia. Efforts to enforce strict racial boundaries and prevent non-white immigration in the first decades of the twentieth century reflected fears about the need to enforce white racial purity and stem a perceived “browning” of the United States, echoes of which can be heard in contemporary anti-immigrant rhetoric.

Grant’s ideas were opposed by both African-American thinkers in the United States and Latin American intellectuals. Du Bois, for example, was an early opponent of anti-miscegenation laws, at a time when this was not a widely shared position, even by the National Association for the Advancement of Colored People. While racists justified lynching (which was rampant at the time) as a way to preserve racial purity by protecting white women against black men, Du Bois defended intermarriage and highlighted the fact that historically racial mixture had largely been the result of sexual violence by white men Eventually the NAACP would lead resistance to attempts by northern legislatures to pass bans on interracial marriage in the 1910s and 1920s. From Latin America, meanwhile, Vasconcelos rejected Grant’s claims that racial mixing between whites and non-whites led to degeneration, and argued that Latin Americans should embrace their status as mestizos (racially mixed people). Vasconcelos also warned Latin Americans of the racism they would face if they crossed the border regardless of their skin color. Latinos were also the targets of racial violence, heightened by anti-immigrant sentiment at the time. From the mid-19th century until well into the 20th century, thousands of Latinos, especially Mexican Americans in the Southwest, were lynched.

Today’s resurgent white nationalism in the United States thus harkens back to early twentieth-century policies on immigration and racial segregation justified in part by Grant’s racist pseudo-science. Then as now, panic about demographic change was the driving force behind racism. In different ways Du Bois and Vasconcelos both responded by arguing that seemingly disparate anti-racist struggles were connected. We need to do the same in our time if we want to oppose xenophobia and racism.

Featured image credit: “Mexican workers await legal employment in the United States, Mexicali, Mexico” by Los Angeles Times. CC BY 4.0 via Los Angeles Times photographic archive, UCLA Library.

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(Sweet and) sour

Last week (September 11, 2019), I discussed the origin of sweet and promised to tackle its partial opposite. Sour has been attested in nearly all the Old Germanic languages: nearly, because, like sweet, it never turned up in the Gothic gospels. The reason is familiar: sour is absent from the Greek texts Bishop Wulfila translated in the fourth century for the benefit of his followers. To the extent that I can trust the concordance at my disposal, the adjective sour occurs in the Bible only in the following passage of Ezekiel XVIII (the Authorized Version): “1 The word of the Lord came unto me again, saying, 2 What mean ye, that ye use this proverb concerning the land of Israel, saying, The fathers have eaten sour grapes, and the children’s teeth are set on edge?” In the modern European languages, the idiom sour grapes goes back to Aesop’s fable about a frustrated fox, but we can see that the image and the phrase were known not only in Ancient Greece.

The famous sour grapes. Fox and grapes by Daniel Schultz, public domain via Wikimedia Commons.

The Old English for sour was sūr, and its cognates elsewhere sounded the same (in the Old Icelandic form súrr, the second r stands for an ending; ú, like ū, designated a long vowel). Such words tend to display a rather broad range of meanings. Therefore, it does not come as a surprise that Old Engl. sūr also referred to things “bitter” and even “extremely distasteful.” In dealing with sweet, we saw that it acquired the sense “pleasant.” Sour, naturally, came to mean “morose, peevish.”

Ezekiel, like Aesop, also knew that grapes can be sour. Prophet Ezekiel, CC BY-SA 2.0 via Flickr.

The question confronting us is familiar: How did sūr acquire its meaning? At first sight, this complex is neither sound-imitating nor sound-symbolic. The history of sweet posed the same question, and the answer has not been found, even if we agreed that the earliest sense of sweet was “producing juice.” From the phonetic point of view, what is or was so juicy about the reconstructed protoform swōte?

As usual, etymologists begin their search by trying to find cognates. Perhaps, they hope, some related form holds a clue to the answer. Some native English words have cognates all over the map of Indo-European (borrowings are a special case and will concern us a bit later), while the distribution of others is limited. For some reason, secure cognates of the Germanic words for “sweet” and “sour” have been recorded only in the Slavic and Baltic languages.

To be sure, in Sanskrit we find sūra “the sap of soma” and surā, the name of some alcoholic drink, while Hungarian has sōr “beer,” but nothing in what little we know about the history of the adjective sour suggests inebriation. There have been attempts to detect the ancient root of sour (that is, sūr) in some place names, for instance, Greek Syracuse and Central Asian Syr Darya (a river name), but this wild goose chase holds out little promise. Equally uninviting is the idea that we face some extremely ancient migratory word (the name of a food product that originated somewhere in the east and spread all over the world with this product). Finally, Latin rūta “a bitter herb” has been pressed into service, with the hope that rūta once had initial s-mobile (then srūta). Those are all unproductive fantasies. In dealing with sour, it is advisable to stay in the Germanic-Baltic-Slavic territory.

Some rivers may perhaps flow with milk and honey, but they never flow with cheese. Syr Darya Oblast. Kazalinsk. Pier of the Aralsk Flotilla by Aleksandr L. Kun, public domain via Wikimedia Commons.

In Russian, we find syr “cheese”; the other Slavic cognates are very similar. The adjective containing this root (syroi; stress on the second syllable: syrói) means “wet.” As already pointed out, Elmar Seebold derived sweet from the root meaning “wet,” ultimately, from “juice.”  Old Engl. sūr-īege, literally “sour-eyed,” meant “blear-eyed”; the word’s cognates in German and Icelandic meant the same. The image must have been of dripping from the eye. Perhaps Russian (Slavic) syr and Engl. cheese evoked somewhat similar associations, if Latin cāseus (from which Engl. cheese was derived) got its name from the idea of foaming and bubbling.

“Sweet” and “sour,” as we have seen, tend to develop metaphorical associations: “pleasant” and “disgusting.” The Lithuanian cognate of sour (sūras) means “salty,” but the most curious case is Russian surovyi (stress is again on the second syllable: suróvyi). The word contains the same root as in syr “cheese”; the vowels alternate in it by ablaut.  Surovyi means “stern,” while its cognates elsewhere in Slavic mean “wet,” “hard,” “fresh; succulent,” and “raw,” in addition to “strict, stern.” All this goes a long way toward showing how careful one should be while working with historical semantics. The ancient complex sūr seems to have been applied to the technology of the dairy industry. A different idea, according to which we should look for the origin of the word in working with clay, rather than milk (it was promulgated by the famous Dutch scholar Jan de Vries, who followed the reconstruction of the German etymologist Jost Trier), looks rather uninviting.

Thus, long ago, people coined the word sūr. We more or less know what it meant (“wet like whey”?); the related Russian syvorotka (stress on the first syllable) does mean “whey.” But the initial impulse behind the coinage is lost. Such is the way of most etymological flesh.

Our story needs one last note. Though Germanic-Slavic-Baltic has been our terrain, we cannot ignore the fact that also in Old French, the adjective sur “sour” turned up. Modern French still has the adjective suret “sour(ish)” and the verb surir “to turn sour” (said about food). The existence of Old French sur may be used to support the idea of a Eurasian migratory word, but, more likely, we are dealing with a borrowing from Germanic, even though we cannot explain why the word made its way into French. Such words come from abroad with things. (Thus did Sorbian tvarog become German Quark.) Was there some German sour milk product that enjoyed popularity in medieval France?

English has preserved a single trace of that Romance adjective. The plant name sorrel is a borrowing of Old French sorele ~ surele. The reference is to the plant’s sour taste. Its homonym sorrel “(horse) of bright chestnut color” is a different word.

This is the end of our journey over the sweet and sour terrain.

Feature image credit: Image by Morana T from Pixabay.

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Cancer patient or cancer survivor? Understanding illness identity.

The good news is that many people now survive their cancer. They are either cured or live with cancer as a chronic illness. However, life after cancer can vary between cancer survivors. Some are almost symptom free and return to a normal life after completion of treatment, while others could experience persistent side effects of cancer and treatment long after treatment has ended.

With the number of people living with cancer growing, there is increasing interest in how these people perceive themselves and their illness.  With the advent of cancer advocacy, traditional terms such as cancer patient or cancer victim, are being replaced by the more empowering cancer survivor. Although some might consider the differences in these terms as semantics, many argue the label cancer patient is dehumanizing, emphasizing the disease over the people themselves.

So why is understanding illness identity important? For example, people who consider themselves as patients might feel less empowered to contribute actively to their treatment decisions, deferring instead to the treating medical specialist. On the other hand, people who are still grappling with cancer and its after effects might feel alienated being described as a survivor, perceiving that their struggles or feelings of suffering are not validated.  Previous research report that people who perceive themselves as patients were more likely to be depressed and have poorer quality of life. In contrast, people who identify themselves as cancer survivors report better health outcomes.

In Germany, it is still not common for people living with cancer to describe themselves as a cancer survivor. About a third of people there who had been previously diagnosed with breast, colorectal or prostate cancer still considered themselves cancer patients 5 to 15 years after the diagnosis. This perception is associated with many factors, such as type of cancer treatment received, whether the disease has recurred or progressed, whether a new cancer is diagnosed, and psychological problems. People who still consider themselves patients were also more likely to make cancer-related visits to a health care specialist or facility.

Besides illness identity, we also need to consider illness perceptions. People with similar clinical characteristics could have vastly different interpretations of the seriousness of their illness. How people perceive and respond to their cancer and treatment could be important in how they cope with and adapt to life after cancer. These perceptions can be shaped by previous experience, current observations, or shared information on illness and symptoms. People with negative or pessimistic illness perceptions were more likely to report poorer self-management of illness side effects, less likely to stick to treatment recommendations, report higher levels of problems like depression and anxiety, and make more visits to health specialists for general or cancer-related matters. Furthermore, negative perceptions have been associated with poorer quality of life and a higher risk of mortality. However, these negative perceptions can be fixed. Therefore, health care providers should consider exploring and identifying perceptions that could be unhelpful to adapting to living with cancer. Addressing how people see their cancer in a more positive light may reduce further medical problems and improve well-being.

Featured image credit: “Man and Woman Raising Hands” by rawpixel.com. Free use via Pexels

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