GUEST: Dr. Michael Lewis
I’m Richard Heffner, your host on The Open Mind. And this is my second program with a distinguished researcher and scholar whose new book, Altering Fate: Why the Past Does Not Predict the Future, calls into question the philosophical and psychological “givens” or assumptions on which we base much of what we think about the nature of human nature and of human development, and then what we do or do not do about it.
Well, Dr. Michael Lewis is University Distinguished Professor of Pediatrics and Psychiatry and Director of the Institute for the Study of Child Development at Robert Wood Johnson Medical School in New Jersey.
And I’d like to pick up now where we left off in our first program.
Dr. Lewis, I’m glad that you’d stay. I referred before to this wonderful chapter on “Cure or Care.” And I wonder if you’d elaborate in your own words on why you used those words.
LEWIS: Both in medicine and in social policy towards families and children, we really have two different views. And I can probably contrast them by talking about wearing glasses.
HEFFNER: As you do in the book about your son, Benjamin.
LEWIS: Yes, I do. And, indeed, since we both wear glasses, quite appropriate. Glasses are a perfect example of care, not cure. We wear glasses, and when we do so we can see relatively well. When we take those glasses off, we can’t see. No one would say to you, after wearing glasses for ten years, “Well, you’ve worn them for ten years. You shouldn’t need them anymore.” We, in fact, recognize that, for much of human behavior, we will need care. We will continue to need to do it because we won’t be able to “cure the condition.” Some of us have hypertension, and we have to take medication. As long as we take that medication, our blood pressure is fine. As soon as we stop, we, in fact, have blood pressure that goes up.
Over and over again we have this contrasting model between care — that is the ongoing attention that people need — versus the idea of cure. In social policy, perhaps a very interesting example is, indeed, the Catholic tradition. No Catholic would ever say, “Well, you go to confession one Sunday, and that should cure you of all your potential of moral ills on the following weeks.” We understand, in some sense, that human beings, being what they are, will continually need the care of confession.
I believe that the model of cure is very much like the model of inoculation. And as I’ve said in the book and we talked about earlier, the model of inoculation is an extraordinarily deterministic model. It is a model which says that I’m going to do something now, and it will completely alter what happens in the future. It will prevent certain diseases from occurring. And if I don’t do it, then, indeed, you’re likely to have them.
So cure, which does exist in some domains, namely, inoculation does work with children. If you inoculate a child against polio, they’re not going to get polio.
HEFFNER: You know, I have to ask you the question then of what the basis will be if cure won’t occur, then what is the basis for your urging care?
LEWIS: One of the uses, perhaps the most important uses, of human beings, because, after all, we can get machines to do a great deal, is the care and concern toward other human beings. Teaching, caring for the sick, children, the infirm, human beings do this best. If we take a care model, as opposed to a cure model, then we will focus on those values, those attitudes which are best for care. We won’t be impatient that we can’t cure. We will, in fact, be interested in the care itself.
I must tell you that one of the contrasts between Western and Eastern medicine is the difference between cure and care.
HEFFNER: Tell me how.
LEWIS: For example: Western medicine is very much interested in acute medicine, very much interested in the idea of inoculation, very much interested in the idea of putting in new organs to replace worn-out, old ones, but not very good on long-term treatment of chronic illness. We have made very little progress in chronic illness. On the other hand, the Eastern tradition of medicine is much more on chronic medicine. It is not on the cure of the chronic illness or the chronic disease; it is on the care of it.
HEFFNER: Are you glad you live in the West rather than the East? That isn’t a smart-ass question only. I’m serious.
LEWIS: I am glad that I live in a time when we are prepared to consider rather one than the other; that both are important. That surely as a society we should move toward cure if we can find it, but simply not give up on care if we can’t.
HEFFNER: At the very end of your book, you write, “Because we cannot predict what will occur in the future.” And, of course, you fly in the face of what many people do say: that we can predict more rather than less. “We have only the current to focus on. It means that our caring must be based on our values rather than on what occurred or what will occur.” You’re saying, “Let’s use values rather than pragmatism here as the basis, as the motivation for what we do.” Do you think we’re capable as a people of doing that? It’s not just a matter of your urging. Do you think, given who we are at the end of the Twentieth Century, that we’re capable of adopting your analysis?
LEWIS: Well, to begin with, of course, it would fly in the face of my proposition to say that we are not…
HEFFNER: Right. We have to be. [Laughter]
LEWIS: …capable of changing. I don’t think human beings are capable of changing just by willing it. I believe that the structure of the society in which we live is, or the particular family environment in which a child is raised, is going to be the determining factors for change.
Can we do it? This is what worries me. I read to my three-year-old for two reasons. I read to my three-year-old because I want him or her to do well in college. And I read to my three-year-old because my three-year-old enjoys snuggling up against me and being in a caring relationship in which I’m doing something in which this three-year-old’s mind is capable of reaching for. If I tell you that reading to your three-year-old is not going to mean he’s going to do well in college, I want us to be able to read to our three-year-old because it’s really good, and it feels good, and the child loves it, and we enjoy it in the now.
HEFFNER: But in a society in which, very practically now, parents are absentee parents more and more, in which children are latchkey children more and more — I’m not talking about absolutes; I’m not talking about everyone — don’t we just need the opiate of the notion that if we do something for them now, if we’re warm and comforting and take the time, it will pay off in the future? Because otherwise, the pressures in our society are such that, while there may be change, we’re not likely to set aside the need for the two incomes in the families that are intact.
LEWIS: You offer good reasons for why we do it. Those are good reasons for why we do it, but it’s not what we should be doing. Yes, we have latchkey children. Yes, the economics of modern life are such that we often need two people working out of the home. Let us construct society, let us, for children, in which we don’t have latchkey children. Why is school over at three o’clock? Why don’t we have programs of care? The fact is we don’t have it because of economic reasons. It makes no sense to have a second earner in a family if you have to spend that earner’s salary on the care of the children. Notice the economics of require that less money be spent on the child than is being earned by the second earner. It’s a bizarre situation.
We pay people less than we earn to take care of our children because it makes no economic sense to pay them the same amount. What are we saying? We are saying, therefore, that the job of caring for our children should not be highly paid. Well, I can easily think of a society in which the job of caring for children should be a very high-paid job. Do you have any idea of what a daycare, a teacher’s aide earns a year? Do people in general know? It is shocking. We need a certain ratio. If the child is under two, you probably need a ratio of an adult to every three children, or perhaps two adults to every four children. It depends on state rules. The second person taking care of that child does not earn enough money not to qualify for welfare.
When we think that what we spend on our children is so meager, someone has to say, “Now, wait a minute. For whatever reasons we’re doing this, for whatever reasons we believe that the first few years are going to do it all for us, we better darn well reconsider it. This is foolish.” We have an increase in social decay and disorganization. More crime, more school failure, more depression among our children. We aren’t doing it right. And, of course, everyone knows that who pays attention. The solution, unfortunately, is: Let’s spend some more, but not very much more. And if you’re going to spend more, well, where’s the best place to spend it? So everyone says, “In the beginning of life.”
HEFFNER: Okay. Let me then ask you a very, very key question. You rule the universe. You’re going to restructure what it is we do. What would you have us do, reflecting your understanding that we do determine our own fate, so we’re not going to scare people into thinking that if care isn’t taken in an absolute way at age three that that’s the end and we can’t remedy this as we go along? What would you do? What would be your social structure? What would be what it is that this particular scholar, with his own sense of the nature of human development, would have us do?
LEWIS: We need to do several things. And, unfortunately it usually turns on whether we can afford it. The question that we ask as a society is not, “Can we alter children’s behavior?” but “Can we do it inexpensively?”
I was consulting for a group of scientists in South America who were taking children who didn’t have proper nutrition, and they decided, well, maybe they’re not doing well in school because they’re hungry. And so they gave them food. And what they gave them was just at the minimum level. And I remember sitting and saying, “Well, now, why don’t you give them the same kinds of food, the same nutrients as you would give your children? Why are you only giving them a minimum?” And they said to me, “Michael, the answer is we can’t afford to feed everyone as well as we feed our children. So can we do it for a little less?” And I said to them, and I say this to you: We have to ask the question, “Can we do it?” before we ask the question, “Can we afford to do it?”
Unfortunately, we mix those two questions. We give Head Start. But I would challenge you to go into a Head Start classroom and see if that would be the kind of educational environment we would want for our own kids.
HEFFNER: You’re saying it’s not enough.
LEWIS: It is not enough. So we are trying to answer two questions. Can we do it? I believe that we can do it, but it’s going to be expensive.
HEFFNER: But isn’t your first question — and this is what I do get out of your book, and particularly your chapter on “Cure or Care” — isn’t your first question the one that has to do with what must we do, not in terms of dollars and cents, not in terms of rehabilitation, not in terms of determinism, but in terms of what you write here at the very end, “We should be as kind to children as we wish others to be to us. We should give children love as we expect to receive it. We should excite their senses and stimulate their minds as we wish it for ourselves. We should reduce their fears and sadness and increase their interests and joys. We should make them care for others as we show them that we care for them.” These are moral commands. These have to do with the values that you embrace. So isn’t your first question, “What should we do?” What, in terms of what our sense of what it means to be a human being, we should do. And only after that ask, “Now, what can we do in these moral terms?” And then, “What does it cost?” Not, “Can we afford it?” Because you seem to be saying, by putting moral values first, the question of “Can we afford it?” really is upside-down. The question is, “Can we not?” or “Can we afford not to do this?” Can we afford not to do this and be the kinds of human beings we want to be?
LEWIS: Yes, of course. Our values, what we know about children and their development, is clearly the basis on which we have to decide what we actually do with children.
HEFFNER: So that I… Let me interrupt and say to you: So I ask you, let’s set aside the question of “afford,” because, in a sense, you answer that when you say, “As human beings we can’t afford not to do what’s right.” Then I come to the question of what’s right in terms of what’s productive from the first five minutes on.
LEWIS: What is productive, of course, is to, as you read, and as I wrote, is, in fact, to adopt a stance vis-a-vis children which is humanistic. We, in fact, as a civilization, are moving in that direction. We, in fact, have eliminated, for the most part, severe corporal punishment, and even murder of our children. We have eliminated making them work. Children were property of parents. They were no different than the chair. They could be bought and sold. They could be thrown out. And we, as a civilization, have moved away from that view. We need to continue to move away from that view. And our laws and our structure are moving us that way. So, for example, children must be attended to medically, they can’t be beaten severely. They can still be punished, and that’s probably appropriate. If they are unloved and brutalized, we are beginning to suggest ways to prevent that. So we know enough about children and what they need to institute change. The reason why I emphasize the economic is not because it comes first; it’s because we now know enough, we have enough information of what we should do for children, not only at the beginning of their life, but all the way through. The question is: Why aren’t we doing it?
Again, think of a family under economic distress, where two parents are working. Just surviving with both of them working. They cannot attend to their children. They are exhausted when they return from work. They can’t answer their children’s questions. They don’t have the energy or the resource to sit and read. So that the economic is not incidental; the economic reflects the structure of the society. And what we have is a conflict between the values and what we know about child care, and the structure of the society which would allow us to carry out those things.
HEFFNER: What would you do, what would you have us do, as a society, about those forces outside of the family that make children, for instance, customers, make them objects in the marketplace? What have your studies taught you about the media and children?
LEWIS: We are conflicted, in a real sense, between what parents should and should not be doing for their children. The educational system is a perfect example. On one hand, we want to hold parents responsible for the education of their children, because without the parents’ input at each point, without them working with their children, the children would not learn well. At the same time, we have a structure in which the parent is excluded from the educational process.
We simply don’t have… We have a system, I should say, of experts, in which the parents turns the child over to. In terms of the media, it’s very clear: parents need to have the control to determine what their children see. And maybe that will be programming individual television sets to make sure children don’t see the things that parents don’t want them to see.
HEFFNER: But if parents don’t have the time, are preoccupied with two persons, when there are two parents around, not being around because they’re making what they insist must be their living, what sense does it make to talk about giving them control again, as the president says?
LEWIS: Yes. But, you see, the problem we have here is that we’ve already set up a structure in which they don’t have the time. There are societies that pay parents to produce good citizens. What if I said to you, “There are twelve tasks in the first five years of life before that kid gets to kindergarten which every child in this society needs to arrive at, that we as experts determine them.” And we can. A love of learning, interest in other people. We can go on. And what if I said, “I am going to pay, I am going to figure out what it costs for social disorganization. What does it cost the society to incarcerate kids? What does special education cost? What does remedial care cost? And figure out how much that costs.” I think we will turn out that it is quite expensive. And we will simply say, “You bring your child, at age one, to X Center, and this center will see if your child has acquired this skill. And if that child has, I’m going to give you parents X thousands of dollars.” Now, suddenly, the parent has a job. We are not prepared as a society to do that. We are not prepared, not because we are not a wealthy society, but because we have placed our emphasis not on children achieving these things.
I was at a meeting a decade ago with business leaders, scientists, and government. The question is: How are we going to meet the challenge of children and development? What was first concluded is: We know enough now. Business said government can’t handle it. Cannot handle the programs that need to be initiated.
HEFFNER: Cannot, or should not?
LEWIS: They said “should not,” but argued on the basis of “they cannot, they’re not competent enough to do it.”
HEFFNER: Do you think government should?
LEWIS: I believe we need a system by which children’s needs which can be specified are, in fact, a given. I don’t much care which structure in the society brings it about, as long as those needs are met. The question is, we know how, what the needs are, we know how to bring them about. What we don’t have is the will to bring them about. You talk about latchkey kids. Yes, why? Why do we have them? Why should they exist? Why are we teaching kids not to talk to strangers? Why are we not protecting children so that they don’t have to protect themselves? We have simply shifted the responsibility for child care away from families, away from society, to children themselves. They are now responsible for themselves.
HEFFNER: Dr. Michael Lewis, that is an appropriate point at which to end the program and indicate that we haven’t moved that responsibility to some other, in some workable way, to some other force.
Thanks again for joining me today and last week.
LEWIS: Thank you.
HEFFNER: And thanks too, to you in the audience. I hope you join us again next time. And if you would like a transcript of today’s program, please send $4 in check or money order to: The Open Mind, P.O. Box 7977, FDR Station, New York, NY 10150.
Meanwhile, as an old friend used to say, “Good night, and good luck.”
N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.