More Thoughts About Thinking the Unthinkable, Part III

GUESTS: Dr. Irwin Redlener and Dr. Lawrence Aber
VTR: 4/22/04

I’m Richard Heffner, your host on The Open Mind. And in a sense this program is still another extension of one we did just a year ago about “thinking the unthinkable, in order to do something about it”.

My guest then and really the intellectual presence behind this Open Mind and others to follow, was Dr. Ralph Gomory, the redoubtable President of the Alfred P. Sloan Foundation who has so wisely insisted that “you can’t ask people to agree that the threat of terrorism is huge and leave it at that. You have to give them something concrete they can do. Because their question is going to be, ‘what can I do about it?’”

Well, here on The Open Mind, therefore that is precisely what I want to ask a number of expert guests on occasional programs over the months to come; from their respective disciplines and vantage points just what practical measures can we Americans take to protect ourselves against terrorism – biological, chemical, nuclear – and in whatever other forms sick minds can conjure up to injure us.

Well, twice now The Open Mind has focused on Americans’ concerns for terrorism and our children. And we do so again today, bringing together our two earlier experts. Dr. Lawrence Aber, Professor of Applied Psychology at New York University, who has also closely studied the impact on 9/11 on children in New York.

And Dr. Irwin Redlener, who directs Columbia University’s National Center on Disaster Preparedness and who helped organize the American Academy of Pediatrics’ Taskforce on Terrorism.

Now each of these gentlemen has watched the other’s initial Open Mind and I would ask whether either one would add practical guidance for viewers to the others’ comments. Gentlemen, what would you add to what the other has said? About the psychological perhaps or about the very practical, “what do you do at home?” aspect of this problem. What would you say?

REDLENER: Well, let me first … I’d like to say something about the general sense of how people and children in particular are handling this kind of new, really flood of information and images that we’re calling terrorism and preparedness and the like.

And the concept of resiliency for people and for our children in terms of what is it that we should be expecting? What is the “norm” toward which we’re aiming around this? I mean I’m not sure that there … that the word “norm” is even appropriate here; but what’s the benchmark about how we would like our children and families to handle emotionally and in other ways, this new specter of terrorism in America. Because it is very, very new.

And I think that part of the problem is that we do want children to be able to … and families … to be prepared and that … and the institutions and systems around them to be prepared to protect them physically from dangers. The question is what is the, the mental health, the psychological equivalent of the preparedness that we do logistically and physically. So that my grandchildren won’t be encumbered more than they absolutely have to be by these images, which are basically unavoidable.

Even if we got the media to agree to limit exposure or other methods of limiting exposure, you can’t eliminate exposure, not only to that, but other kinds of trauma in lives; and I actually would ask Larry what his thoughts about how do we make ourselves more capable of coping with bad possibilities than we currently are; we’re not the Israelis having had the decades of experience, horrible experiences, where we’ve become inured or somehow accustomed or learned how to handle this. What should we do in America, is really the question.

HEFFNER: Larry?

ABER: Great question and there’s probably several paths to take. One that is developing and that we could give a big boost to is the movement in US schools to incorporate social and emotional and character development into the curriculum as well as cognitive development in reading, writing and ‘rithmetic.

We have the biggest socialization institution in America, outside of the home … the school … which has been fairly willfully ignorant of children’s emotional development. And emotionally healthy, socially sensitive children who’ve learned how to cope with interpersonal conflict and dangers in their own lives, which surround them all the time, will be more prepared to cope with disaster.

So … and this is happening all over the country, but it’s still an uphill battle. The standards movement in American education that we’re going to evaluate how schools do against children’s progress in reading and math only has crowded the curriculum out in terms of social and emotional and character development experiences … number one.

And number 2, has created a benchmark where we’re not as … we don’t monitor children’s coping, their mental health and we need a positive program to do that. So that’s one way of doing it.

HEFFNER: It’s so interesting to me that you talk about the schools as the great place outside of the home and I think of Marshall McLuhan’s statement that “every school child knows that going to school interrupts his education”. And I wonder, not to pick up the argument that we had in our previous program, but to pick it up … why not …

ABER: MmmHmm. MmmHmm.

HEFFNER: What about the media in terms of answering your question …

REDLENER: MmmHmm.

HEFFNER: Do you see a role for that educator?

REDLENER: I do, in fact, programs like the Sesame Street programs where there is actually a lot of focus and interest in this idea of coping. And they’re actually exporting a lot of these ideas in programs internationally, just as an example of what could be done with, with media that is engaged and interested. So you see programs, for example, involving Palestinian and Israeli children working together, playing together, dealing with conflicts in different kinds of ways. And, and I do think there’s actually the flip side of the, of the bad part of the media exposure … is the possibility for using the media in positive ways, that can actually be entertaining, somewhat like this show even … to inform people …

HEFFNER: This show?

REDLENER: … I’m making a leap, but let’s just …

HEFFNER: … All right.

REDLENER: What I’m saying, seriously, is that I do think it’s, it’s possible to, to use the media in a very appropriate way to help children understand what’s going on in their lives, and in fact, it helps families and parents as well. And I, I think there … that is one thing that could be done.

The media is such a mixed bag, it’s almost hard to talk about it as if it was one homogeneous issue or one, one simple … some simple institution. It’s actually a very complex institution having multiple effects on people, probably good and bad and in-between and mind-numbing and gaining weight because people become couch potatoes. But on the other hand, it is a vehicle that could be exploited or explored more for good in these kinds of ways.

HEFFNER: May I … may I ask this question … I think I pointed more to you, Larry Aber … in terms of the matter of using the media … you do … using our schools … even our homes positively … what is the positive message, that we as a society can convey to our children in the light of terrorism?

ABER: Children want and need three or four things in those situations. They want and need parents who are emotionally available to them and they’re able to help protect them. So … the one of the things we know that disrupts kids most is when their parents are so distressed under these circumstances, that they, they can’t care for their kids.

So one positive message is “Mom, Dad, anticipate how you can get support, how you can get your head cleared around this, to be available to your children”. And, and don’t … be realistic, but to the extent that you express your, your fear and your panic in a certain way … you’re going to scare your kids as well. So, that’s message number one.

Message number two … there is no disaster I know of where the desire to return to normal activities, as soon as practically possible, isn’t a good one. Schools should anticipate … “how long do we have to be down under certain circumstances”. Families should figure out “how are we going to have a meal together, even in an emergency. It sounds like silly things, but the return to normal activities is not a form of denial of what happened, it’s creating the space required for people to regain the strength and perspective to go out and do it again.

So care, protection from parents; parents taking care of … it’s like the airplane … parents put on your own mask first, and then help your kids. And then the idea of “how can we return to normal activities, in the face of chaos?”

I’m talking about experiences that Lebanese families had in the middle of shellings and bombings, trying to create normal … quote regular … supportive activities. Meals together. Bedtime rituals. Silly, concrete things like that.

REDLENER: And actually I totally agree with Larry, and this is … he’s talking about things that actually become the basis for the practical discussions that we want … say, pediatricians to be having with families who come and say, “what do I do? And how do I get prepared? My kids are very anxious and I’m very anxious.”

And I think what he just said is the basis for a fairly prescriptive set of things that we suggest to families that are not only important in dealing with crisis, but actually can improve the emotional context of a home. In other words, if we say it’s good in time of crisis for you to be as close … to be available, be close to your kids, be physically next to them, limit television … understand what the routines are that are important to your family, including mealtime, play time, reading, weekend activities, all of those things which we say to do in response to kids being traumatized by what they’re seeing or hearing, actually have great beneficial effects on the way families function in general.

So it’s not just the theoretical abstract notion of, sort of getting in touch with these issues, but they’re really prescriptions for how families can function in healthy, better ways, a lot of which we forgot about in our busy lives in dual working families and kids with intense schedules. Those basic issues of family closeness, which are so fundamental, can become horrible problems in the face of a crisis.

So, re-finding those things that are important to family life, and family functioning are, are both helpful in resiliency in general, as well as the kinds of things we want to do in response to a major event.

HEFFNER: Do you think that your fellow pediciatricians, and it’s a strange question, are capable of conveying that to American parents?

REDLENER: Well, I’d like to say “Yes”, I think they … I think they are … they’re interested, as a group … predications really do increasingly like to understand and focus on, on the environmental … emotional environment in context of families. We’re asking pediatricians to think about the evidences of child abuse and neglect, family dysfunction, domestic violence.

We’re wanting pediatricians overall to become more sensitive to these issues. So, yes … and they are.

HEFFNER: No, that’s what I’m asking you about?

REDLENER: Yeah.

HEFFNER: Are they becoming more sensitive?

REDLENER: Much more so than they were 20 years ago. You know, this is cynical me speaking here and I, I really do believe that we’ve … pediatrics, at least, has made great strides along these areas. And there’s been a lot … a lot more emphasis in the training programs and even in medical school about, about understanding these things. And we’ve come a long way. Have we reached where we need to be? Not, not by a long shot. But I think progress is being made.

HEFFNER: Larry, in, in talking about families and talking about schools, I remember right after 9/11 my grandson being so upset, because in his school, in his middle school, teachers felt that they should be constrained from … they were constrained from discussing the whole business … they felt it was the parents’ business. And they wouldn’t even discuss the darn happening in school.

ABER: That attitude is part of the attitude that separates children’s social emotional lives and expectations from their cognitive and academic ones. We do have a, a … a culture in conflict about the degree to which personal, social, emotional issues are really a part of, and should be a part of public education because public education is government and those issues are familial and private. And so our long-standing cultural issues about that come to play there.

But you, you make me think of another point which is that teachers at that moment are not only teachers, but they’re most often the parents and spouses of other people. And another domain that we should be thinking about is the work place in preparedness.

I remember on 9/11 I was having a morning coffee with one of my colleagues, preparing for the day. About 30 or 40 of the people at the center I ran were at work, 10 or 20 hadn’t gotten there yet and I was torn between my work responsibility to the 30 or 40 people who were there and their desire to get to their families and my desire to get to my wife and my son and my daughter.

We have emergency phone chains under other circumstances. There could be work protocols that help people reconcile their work responsibilities and their familial needs and desires under these circumstances. Lack of rehearsal is chaos.

REDLENER: Yes.

ABER: The kind of rehearsal that Irwin was talking about … we need to negotiate those work/family responsibilities in the face of terror, prior to the next event … not, not after.

REDLENER: And actually, this is a very interesting point as we have some colleagues at Columbia … Dr. Robin Gershon, for example, who’s just completing a study now on ability and willingness to work … of hospital and public health workers in the event of a major bioterrorism crisis. And, I guess, I was going to say “much to our surprise, but maybe not”, a lot of people won’t come to work or stay at work, if they’re in fact torn by these familial needs, to be with their family … to make sure their kids are safe, and all of that. And I think this is, this is a very important point.

But I want to come back to the school issue for second because this is a very … it’s actually somewhat of a controversial point, about how much proactive probing should the teacher do, in, let’s say your grandchild’s case … should the teacher … let’s put aside the question of how much discussion should there be … should the teacher bring it up, for example, to a class room of say 20 students?

Not knowing, and I don’t know where I come down on this exactly … which of the children have been very effected, which of the children have not been effected at all. You’re dealing with basically an unknown pool of people. It’s not … when you’re in a one-on-one situation … and you’re getting cues and information and your … from parents and the child … you develop a certain way of relating this kind of information.

If you’re dealing with 20 children who may have had very, very different kinds of experiences, it is a little bit challenging … let me put it that way … for a teacher to know how much to discuss. How far to go. Does the teacher say to the kindergarteners, or first graders, draw a picture about 9/11. Some cases that might be a good thing, in some cases that might not be a good thing.

You know I’m not a psychologist but, but … I just don’t know. I think there’s … there’s … it’s worth discussing because it’s not clear what we do in the larger group’s settings of this type. Actually I would be curious about Larry’s opinion about this. But … it’s not, it’s not necessarily a “one size fits all” thing.

ABER: I, I agree with you that it’s of concern and I am not in favor of teacher intrusion into children and provoking them into discussions about traumatic events like that. I … I’m also not in favor of sweeping it under the rug and pretending it didn’t happen. We live in the complexity of the middle there. And there is research that can guide us … in the earlier program with you I was distinguishing … psychological de-briefing as a therapeutic technique and cognitive behavioral therapy.

To a person unfamiliar with these two they might look somewhat similar in a certain way. The actual processes are based on different understandings of how the brain and the emotions work. One doesn’t seem to have a positive effect, one does. So, if we want teachers to talk to children, we want them to be skilled in it and we want them to use evidence based …

REDLENER: Exactly.

ABER: … approaches, not guess. We would like to have a body of, of research to guide skilled interactions rather than leave it up to the discretion of the accident of how the teacher felt that day.

HEFFNER: Well, from your different vantage points … are we doing anything through the school system? Is there a protocol now that relates to what happened … at 9/11?

ABER: In the New York City school system, both the school system and the, the public health and mental health systems have begun to develop in, all schools and have, in some schools, emergency response teams. They vary a lot in quality and preparedness. Those emergency response teams are having a hard time holding on to funding and resources and priority in the face of the kind of desire to have kids score better on tests and the kind of very significant structural school reform that’s going on in the city.

REDLENER: This is …we’re now being bitten by the beast that we’ve created here. Which is to say … maybe it’s a little too much to say that, but, but … here’s the problem. We have relished and cherished in America, individualism, creativity, a school system doing its own thing, figuring out how it’s best going to implement its curriculum; how budgets are decided, where resources come from and we have millions of islands of interest, expertise, etc. We don’t have consistent policies, there’s no way to wave a magic wand and have a consistent, evidence based methodology for dealing with … for helping teachers do what they need to do in the classroom. There’s just no way to do that. Any more than there is to say to all the hospitals, all 500,000 hospitals in the country at one time … “here’s what you’ll do for preparedness”.

Our society doesn’t work like that. So now when we really need to have consistency and an overarching policy that gives a template or a way or doing, a way of going about solving a problem or meeting a challenge … we’re stymied by the system that we’ve been living by. It doesn’t work. This is why … if you look at Israel, for example, and their ability to response from the health and public health side to terrorism … all the hospitals and public health entities and community health assets fall in line under a national plan in the time of crisis. You can’t … you can’t get two hospitals in New York City to work together.

So we just are in a very difficult place from which to develop this kind of centralized, well thought out plans that could be rapidly implemented in the system. And this is, this is one of the major impediments to making progress in America around dealing with terrorism in general.

HEFFNER: Would you gentlemen each, individually, respectively not do so, or do so … wish to impose some of that unifying force upon hospitals in New York, in New York State, in the Northeast, in the United States, for instance? Or not? Are you going to bite the bullet?

ABER: I’m the oldest of six kids in an Irish Catholic family and I don’t have any problem being a boss. So I, so temperamentally I’m okay with that. But my five brothers and sisters have taught me that I cannot impose on them without some way of creating some shared perspective on it. So I …and I don’t know whether Irwin and I are going to agree or disagree … I believe in public and national leadership on this and clarity and forcefulness. But we do not know enough about why hospitals, teachers, schools don’t currently implement evidence based practice. We don’t … we are … we know that they don’t, but I actually believe that we actually have to make, as an object of our, our study in part, what makes it possible for folks to be able to be using the best practices. This is true in many, many different parts of life. From highly technical medical interventions, to innovations in child psychology to educational innovations. We, we, we don’t know enough about that … so …

REDLENER: But the, but the problems that … well, I actually agree with Larry … to the extent that we don’t have a central direction and a roadmap to do certain … to solve certain kinds of problems, it leads to enormous inequities in who gets what …

ABER: That’s right.

REDLENER: … so, right now, for example, we have underserved communities, forgetting about even terrorism in post-9/11 who have inequities related to the fact that we don’t have a consistent understanding of what children need in terms of access to health or mental health services, for example. So you go in our city to three-quarters of the neighborhoods where those services are very, very difficult to get, even basic services …

HEFFNER: Wait a minute …

REDLENER: … so …

HEFFNER: … let me interrupt you. You say we don’t have the knowledge, we don’t have the information …

REDLENER: The will.

HEFFNER: Ah, the will …

REDLENER: The will.

HEFFNER: … that’s very, very different.

REDLENER: Yes, of course.

HEFFNER: And, ahh, again I come back to the matter of imposition. Larry, over here says that he’d be willing to, but he knows from his experience in his family and in our society, that that imposition is not going to work. I suspect you don’t quite feel that …

REDLENER: I don’t quite feel that way because, you know, and I … believe me, if you knew me better … politically, etc. I’m going to try to get this out without sounding like, like a maniac … but here’s the deal. If we have a military, which we do, and we said the field commanders … “you know what, figure out … what … we generally want to take over this country, or we want to repel this invasion and each of you kind of just figure out what you’re going to do, but at the end of the day, we’ll try to you know achieve something”. And we let it … you know, we let the field commanders … and then they would talk to the platoon leaders and say, “you know, guys, try, try to get over there somehow … I really …that’s an important hill, we really …we need to take that and let me know if you need anything”. That would be the equivalent of how we’re running Homeland Security and preparedness in America right now. It’s a loose band of entrepreneurs with mixed amounts of resources and very mixed agendas, that we’re basically telling them, “you know, just kind of … see what you can do here … we’ll try to provide some resources.”

It’s absurd. If this is in fact a time of emergency, a time for coalescence, we’re dealing with the Pearl Harbor of our day, which was what 9/11 really was. And after Pearl Harbor, it was very clear, we militarized, we mobilized, we did things with the economy, we put women into the, into the workforce in a dramatic way and we, we did Victory gardens and we did … that’s what we did, we didn’t leave it up to random actions of citizens and institutions to do whatever they thought might be sufficient.

HEFFNER: And that’s the point, when he said what I wanted him … what I wanted to hear … we do owe our children more and better.

ABER: Absolutely.

HEFFNER: And I thank you both for joining me today, try to think through how we can give our kids and our grandchildren what they deserve.

REDLENER: It’s a pleasure.

HEFFNER: Thanks, gentlemen.

ABER: Thank you, Richard.

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 $4.00 in check or money order to The Open Mind, P. O. Box 7977, FDR Station, New York, New York 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.