When the Bough Breaks, Part I

GUEST: Dr. Lawrence Aber
Title: “When the bough breaks…”
VTR: 12/05/01

I’m Richard Heffner, your host on The Open Mind. And today’s program stems largely from what my wife told me recently about a wonderfully challenging Symposium she’d attended, one presented by the Center for Psychoanalytic Training and Research and the Sackler Institute for Developmental Psychobiology at Columbia University’s College of Physicians and Surgeons.

Of course, Dr. Elaine Heffner is the psychiatric professional in the family. I respect her judgment. And I was particularly intrigued by the Symposium’s cleverly evocative title, “When The Bough Breaks”. For surely we all remember: “Rock-a-bye baby on the tree top. When the wind blows the cradle will rock. When the bough breaks, the cradle will fall. And down will come baby, cradle and all.”

And just as surely we are aware that too often, all over the world, in our own country as well, the wind blows, the bough breaks and down come our babies, cradles and all. The question, of course, is what do we choose to do about it?

And to begin what I hope may become a series of Open Mind programs dealing with our children and the various trauma they face — terrorism and war, poverty, abuse, debilitating diseases, parental and societal indifference or ignorance — I have asked to join me here today Dr. Lawrence Aber, Professor of Public Health at Columbia University, Director of its National Center for Children in Poverty, and Co-Director of its Institute for Child and Family Policy.

Now at the Columbia Symposium on “When the Bough Breaks”, Dr. Aber commented on this dire situation’s implications for research and public policy. And I would begin by asking him today to tell us what research and what public policy? Fair question?

ABER: Absolutely a fair question. But it reminds me a little bit of…Woody Allen’s definition of theology in his comic… college syllabus … Theology 101, introductory, introduction to the Creator of the Universe through informal lectures and field trips.

HEFFNER: [Laughter]

ABER: And the, the scope of the challenges you just described are so enormous and have been with us for so long. Your viewers need to only think about the story of Abraham and Isaac. And I remember reading to my son that story and that Abraham took Isaac up to the mountaintop and was going to sacrifice him. And my son’s eyes grew enormously big and he said, “He was going to do what?” And … Solomon and what he had to decide in the slaughter of the innocents. So I, I begin with all that to say that I think science can provide deep insight into the challenging conditions facing children and families. But we have to be humble about it. These issues have been with us, literally for millennia, and take a pretty humanistic point of view about it all too.

What have we learned from, from research? What do we need to learn from research? It’s really only been in the last 50 or 60 years that we tried to apply science to understanding the effects of major traumas, like sustained and deep poverty .. family violence … community violence on children’s development.

And back in the sixties we couldn’t even accept it. I don’t know if you know the story about how child abuse … battered child syndrome really was became quite prominent. But a radiologist named Henry Kempe in Colorado was trying to discover why some children came in with repeated fractures of their bones. And he was trying to isolate some kind of bone disease. Because the parents and the children didn’t report that the child was being abused. And, over time, he finally realized that these stories are improbable and that some children were being beaten severely by their parents. So, in some ways what research can do is provide evidence that children and parents couldn’t all by themselves … about some of these things. And help us not hide our eyes from some of these things.

A second thing that’s … and science has begun to do that and we can talk more about that if you want. Another thing science can do is help us understand when these things happen, what are their likely affects on development? Why do some children seem to do relatively okay even in the face of adversity. And why some kids don’t.

And then, for me, the most important thing is the action issue. Science can help provide some guidance about what we can do to prevent these problems or to help children recover from them.

HEFFNER: First, “hide our eyes”. That’s an interesting thought. Does it mean that we are not as child centered a society as we’ve always touted ourselves as being?

ABER: I think we are … thou doth protesteth too much …

HEFFNER: Mmmm.

ABER: Yes, we are very child centered in many ways. But in many ways we don’t figure out how to help children because it often means helping parents that we don’t like. And …

HEFFNER: Say that again.

ABER: Ahemm …

HEFFNER: … Or run through that …

ABER: Sure.

HEFFNER: … explain it …

ABER: Sure. In the United States today about one in six children live in families with incomes below the poverty line. Poverty line for a family of four in this country is about $17,000 a year. Not, not a…a grand sum. And, and one in six kids live in, in families with…making that little. Most Americans don’t know that figure. It’s widely available. Most Americans don’t know it. Most Americans assume that… children who are very poor have parents who are unworthy, who… aren’t doing what they need to do. And so, they resist the knowledge that children are in trouble and they resist the, the evidence-based strategies we know about how to help them in part cause they’re angry at the parents and they want to blame the parents. And it takes helping the parents to help the kids.

HEFFNER: This sounds like the Social Darwinism of the 19th century.

ABER: It…I think it’s related to that. I think it has even deeper and more fundamental roots. I think it has to do with America’s preference for understanding things in highly individualistic ways. I think we are a country that … the, the belief that individuals can make it on their own, that…they, we don’t want a nation-state meddling in private family affairs. It…and combined very powerfully to reduce our belief that we can have a community, or collective responsibility for kids that can be exercised in a good way. We … the most recent Welfare Reform Bill was the “Personal Responsibility and Work Opportunity Act”. And certainly there is plenty of personal responsibility that to be part of it. We need a community responsibility part, too. And our fundamental ideology and values I think make it hard to mount some of things we know that work.

HEFFNER: The researches that you do. What are the age groups that you’re concerned about? We talk about children, what do we mean?

ABER: Well, I…I had a professor in college who said that adolescence ended roughly around 30 or 35 …

HEFFNER: If then.

ABER: … If then. And certainly the whole tendency in Western civilization over the last two centuries is to advance the age, extend the age of immaturity. And that sounds bad at first, but in evolution and in human development, the longer the organisms are in a relatively immature state, the more they can learn. And, and so, so there’s a way in which an extended… immaturity is what’s needed in an information society for children to learn, and to…to…enormously complex things, we talking about. When I talk about children, I tend to talk about … and most official statistics talk about children zero to 18. And so from the pre-natal period through the transition from school to university or work. After that most Americans think of people as, as late adolescents or young adults. But, there’s no bright line. It, it … by the time children are truly self-sufficient, it’s often late into their twenties or into their thirties.

HEFFNER: So the cradle grows larger and larger.

ABER: The cradle, the cradle grows larger, and we’ve got to rock it a lot harder. [Laughter] And, and each stage presents different challenges. Children pre-natally and the first two years of life require a different type of care and protection and input from parents, and support of parents from society than the pre-school or the school age child. And the adolescent making the transition from school to, to work

HEFFNER: The…I understand what you’ve said about the attitude of most Americans toward the children who are in need. This is a function of our not liking their parents.

ABER: Right.

HEFFNER: … who are not taking responsibility for them.

ABER: Who we believe aren’t.

HEFFNER: Why do you say that?

ABER: Well, let’s take an example … what Americans often feel about poor children is that if their parents only worked harder, they’d be able to provide for their children and their children wouldn’t be poor. Most Americans don’t know that before welfare reform 61% of poor children had parents who work. Now it’s up to 69% of, of poor children have parents who work. You can work 40 hours a week, 50 weeks a year in this country at the minimum wage, and make about two-thirds of the poverty level. So… it’s not just a matter of personal responsibility. There are, there are many jobs in this country that will not sustain a family and children become young adults not having prepared to compete for non-poverty wage jobs. Is, is…so, that’s what I mean by “appears” to .. to blame…the parents “appear” to be…to blame. It’s not clear to me that an 18 year old young woman who… has faced a certain kind of experience herself arrives on the threshold of adulthood not being able to compete in the marketplace for… a non-poverty wage job. It‘s only her fault that that’s the case.

HEFFNER: Now, you’re talking about matters economic.

ABER: MmmHmm

HEFFNER: But those aren’t the only …

ABER: Not at all.

HEFFNER: elements that are threatening children.

ABER: Right. Right.

HEFFNER: What are the others?

ABER: Well, the two big evils for me are, are poverty, which we’ve been talking about and violence. And violence is … takes many, many forms. There is intimate family violence. And so, child and abuse and neglect. Domestic violence. There’s community violence. And there’s systematic state violence. And all the shades in between. We were talking about Solomon … I mean Solomon made a, a decision to try to eliminate the Messiah by killing a bunch of babies. It was state supported infanticide. And we were talking about Abraham and Isaac. And there’s a whole Rabbinical tradition that suggests that Abraham wasn’t sure that Isaac was his son. Back then there was a question about paternity and how long gestation was. And, and if you weren’t sure about that, it led to infant sacrifice, in part. That, if, if you didn’t know that was propagating your genes you weren’t going to invest in it. And, and that some Rabbinical scholars think that the story of Abraham and Isaac, which is the relationship of…of Yahweh to the people of Israel, has to do, in part, with the ban against infanticide. So, so I think that violence between adults and children, whether it’s state supported or intimate within a family, has been with us for a very, very long time. And it has enormous effects on development. Children experiencing violence, to grow up in toxic environments that affect how they think, how they feel, how they relate, how they learn.

HEFFNER: Now this question leads me to ask you… do you think that psychologically speaking violence is a function, on a larger scale of questionable paternity in a large sense?

ABER: I think that… violence is multi-determined. There is no single cause of violence. I think, to the extent that adults… have reason to question how deep the connection is between them and their children, it reduces their… tendency to invest. And can cause an inclination toward responding more violently. Now it…I say all this … pretty soon you’re going to ask me to leave the show because we’re talking about simply “doom and gloom”. My wife sometimes calls me Professor D&G, and I’m actually a very optimistic person.

HEFFNER: [Laughter]

ABER: And there…there’s all sorts of good things about kids… how kids are doing. And, and…and I always look at these things, in part with a, a view toward “how can we learn from these to help make things better?” So…and I know we’re going to get to that, but the …I, I hasten to add that … I’ll give you a piece of data.

Children in step families are more likely to be reported as abused, neglected than children in, in biologically intact families. That would be a piece of evidence in support of …

HEFFNER: Right.

ABER: … what you just described. Several other things are true of step-families, too. And most step-families are enormously loving and take care of their children. So we’re talking about small changes in probability that put some children at risk. Not the kind of thing that is true of all step-parents by any stretch of the imagination.

HEFFNER: But I’m sure that when you talk about violence in children you’re talking about a whole range of things …

ABER: That’s right.

HEFFNER: … in our society.

ABER: That’s right.

HEFFNER: You mentioned government before. Did you mean then war?

ABER: Yeah. Sure. I had the great privilege of spending about eight or nine years as the Director of a thing called The Project on Children in War at Columbia. And one of… the, the UN and UNICEF asked if a law professor and I would get some people together to begin to think about how war affected children. And how the International Convention on the Rights of the Child could be developed and used to protect children’s rights in those situations. Back in the eighties UNICEF was mostly concerned with morbidity and mortality issues … how to keep children alive. And it’s really only been in the last 15 years that UNICEF said “well, if we keep children alive, what about the quality of their life?” When they looked to those issues children in areas of armed conflict was one of their biggest concerns. There’s now about 40 conflicts around the world in which children have been victims or child soldiers, combatants. And…we, we can think of them all. And the modern face of war has changed quite a bit. It’s no longer inter-state conflict usually. It’s usually intra-state conflict between warring factions. So the face of war has changed, how that affects children has changed. So we’ve studied children in Lebanon, Kuwait, Mozambique, Angola, El Salvador, Guatemala, so … Middle East, Southern Africa, Central America. And, and we needed to understand the quite great variety of war-related experiences that children faced. How it affects their health and development and in turn feed that information back into humanitarian relief agencies, who have the job of helping children and families recover during and post conflicts. So war is, war is one of the greatest acts of violence against children and families.

HEFFNER: And the war that manifested itself at the World Trade Center and in the Pentagon in September?

ABER: It was …

HEFFNER: What about the children affected there? Are you doing research?

ABER: Well, all of the research I do that is like this is, is what I refer to as action research. It’s research to inform action. And so, just like the research that was being done in Central America and the Middle East and, and Southern Africa was in concert with humanitarian relief organizations. The research that we are beginning to do in New York City is in concert with the basic child serving agencies. So, there is work that is being designed right now on assessing children in New York City’s exposure to war related events. How many children saw the attack? How many children lost parents? How many children spent extended periods of time in a period of physical danger? How many children spent extended periods of time worrying and not knowing about whether their parents were safe? These kinds of things are known to be associated with the post traumatic stress disorder, what we used to call “shell shock” in soldiers. And is now a known mental health… disability. And, and so we have to do the population studies. We have to describe the variation of exposure, assess how many kids have had those kinds of reactions, as well as other kinds of reactions to guide people in the education system, the health system, the mental health system, and community based organizations to design the services that are needed to help children recover.

HEFFNER: We’re almost three months away …

ABER: Right.

HEFFNER: … from September 11th …

ABER: Right.

HEFFNER: … what do you know now?

ABER: Well, there have been several quick telephone kinda studies and it is clear that children have elevated experiences city-wide of problems going to sleep… worries about leaving their parents. It’s still a minority of children who experienced that, but it’s at rates two or three times higher than what existed before. There’s tons of descriptive evidence about what’s happening in, in near Ground Zero. There are three… academic and health providers in southern Manhattan … St. Vincent’s, NYU Child Study Center and the Jewish Board of Children Family Services that have had a, a service relationships with the schools in southern Manhattan pre-dating September 11th. And they have reported an enormous range of experiences … from children who, at the extreme form refuse to go to school, or having traumatic flashbacks and having symptoms like their hair failing out, through to children who are determined to go on with life, will not let this disrupt them and, and are very willfully pursuing things. And that range of experience is enormously great and they’re all in the same schools. And so how do you, how do you create services that help the school as a whole and that deal with that range of experiences?

HEFFNER: And the age differences?

ABER: We don’t know yet in New York City what this is like, And New York City is … combines the elements of a natural disaster, which is “it happened once, we don’t know if it’s going to happen again. It was big and horrific.” And the elements of war, which is “we know who did it, it’s systematic, it could happen again.” In … certainly in situations of protracted conflict, children in Afghanistan now have lived their whole lives in war related conditions. So do children in Lebanon and, and Guatemala and El Salvador. There the older you get, the more you’ve been exposed. And so, in a certain way, the older you are, the more affected you are. In situations where it’s a one time situation, probably the younger you are, the more vulnerable you are. So you have to really know what the nature of the traumatic event is like to be able to judge whether children who are older or younger are more vulnerable versus less vulnerable.

HEFFNER: Two questions I would ask about that. One … are there comparisons now with children let’s say in Israel who are growing up, for many years now, with the knowledge of alerts of one kind or another, of attacks of one kind or another. Of buses blowing up, civilians killed.

ABER: There are several networks of scientists and researchers and clinicians working on these things world-wide. So there is a society of, of … studying traumatic disorders and, and how to treat them in children and adults. And they’ve done some comparative studies. There is … the, the recent initiative by the special representative to the Secretary General of the UN, Kofi Annan, the Secretary General appointed an African diplomat named Olara Otunnu three or four years ago to be his special representative to work on issues related to children in areas of armed conflict. And he held a meeting last summer in Italy to begin to create an international research network, an action research network on understanding the affects of war on children, how it can be…how problems can be prevented and how problems can be overcome. And then there’s a “within” nation network. The Federal Government has recently funded a network of trauma studies programs, and these are all action research … nobody’s studying this not in the context of doing something for kids. And it’s, it’s directed by Robert Pynoos who’s a psychiatrist at UCLA. But there are many… centers through out country. So there’s … there is a growing research infrastructure about this.

HEFFNER: Why do you …

ABER: Nationally and internationally.

HEFFNER: Why do you say, several times, “action oriented”,you’re…it’s almost as if you would feel you would have to apologize if these weren’t action oriented programs.

ABER: I, I don’t want …I’m Roman Catholic by tradition, so my natural posture in life is one of guilt. But the … that’s, that’s as autobiographical as I can answer the question. On a more… public level, I, I think that the public should be… very disenchanted with people who have a detached scientific perspective on these issues. A, a perspective that only studies it. And there is room in the world for such activity, it’s not ignoble. It’s not unworthy. It’s not what I think we need at the moment. And there are people who want to act without thinking and people who want to think without acting. And I think most of us are in the middle. And we need to be even more so.

HEFFNER: We only have two minutes left for this program … and I then I hope you’ll stay and we’ll do another one because there’s so many …

ABER: I would be honored.

HEFFNER: … questions to ask you …

ABER: I would be honored.

HEFFNER: The terrorist acts in September. To what extent are there studies being made of children outside of the, of the New York area, where they knew it happened and they saw it again and again and again on television, but they weren’t at Ground Zero.

ABER: There are some studies going on nationally that are trying to understand the effects on children of seeing through the media this event. And there is a lot of interest in doing that. There’s a group at the University of Michigan at the Institute for Social Research that has been doing some national survey work with children. They’ve done it more with adults and they’re now beginning to do it with children. I think that there are two groups that I’d especially call attention to. One is Arab American children. I, I do think that whether Arab American children live in New York or not, they … the meaning of their lives changed dramatically on September 11th. And we’ve read about incidents of discrimination and bias after the attack. And we don’t read as much now, I think the acute phase of that is over. But I think the subtle issues about how Arab American children are going to face the future is a, is a very big issue. And then the second group of children nationally are children who already have been exposed to violence in other ways. And they are especially vulnerable to, to being influenced by this.

HEFFNER: Let’s stop and come back.

ABER: Pleasure.

HEFFNER: Thank you.

ABER: 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 four dollars in check or money order to: The Open Mind, P. O. Box 7977, F.D.R. 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.
HE OPEN MIND
Host: Richard D. Heffner
Guest: Dr. Lawrence Aber
Title: “When the bough breaks … “
VTR: 12/05/01

I’m Richard Heffner, your host on The Open Mind. And today’s program stems largely from what my wife told me recently about a wonderfully challenging Symposium she’d attended, one presented by the Center for Psychoanalytic Training and Research and the Sackler Institute for Developmental Psychobiology at Columbia University’s College of Physicians and Surgeons.

Of course, Dr. Elaine Heffner is the psychiatric professional in the family. I respect her judgment. And I was particularly intrigued by the Symposium’s cleverly evocative title, “When The Bough Breaks”. For surely we all remember: “Rock-a-bye baby on the tree top. When the wind blows the cradle will rock. When the bough breaks, the cradle will fall. And down will come baby, cradle and all.”

And just as surely we are aware that too often, all over the world, in our own country as well, the wind blows, the bough breaks and down come our babies, cradles and all. The question, of course, is what do we choose to do about it?

And to begin what I hope may become a series of Open Mind programs dealing with our children and the various trauma they face — terrorism and war, poverty, abuse, debilitating diseases, parental and societal indifference or ignorance — I have asked to join me here today Dr. Lawrence Aber, Professor of Public Health at Columbia University, Director of its National Center for Children in Poverty, and Co-Director of its Institute for Child and Family Policy.

Now at the Columbia Symposium on “When the Bough Breaks”, Dr. Aber commented on this dire situation’s implications for research and public policy. And I would begin by asking him today to tell us what research and what public policy? Fair question?

ABER: Absolutely a fair question. But it reminds me a little bit of…Woody Allen’s definition of theology in his comic… college syllabus … Theology 101, introductory, introduction to the Creator of the Universe through informal lectures and field trips.

HEFFNER: [Laughter]

ABER: And the, the scope of the challenges you just described are so enormous and have been with us for so long. Your viewers need to only think about the story of Abraham and Isaac. And I remember reading to my son that story and that Abraham took Isaac up to the mountaintop and was going to sacrifice him. And my son’s eyes grew enormously big and he said, “He was going to do what?” And … Solomon and what he had to decide in the slaughter of the innocents. So I, I begin with all that to say that I think science can provide deep insight into the challenging conditions facing children and families. But we have to be humble about it. These issues have been with us, literally for millennia, and take a pretty humanistic point of view about it all too.

What have we learned from, from research? What do we need to learn from research? It’s really only been in the last 50 or 60 years that we tried to apply science to understanding the effects of major traumas, like sustained and deep poverty .. family violence … community violence on children’s development.

And back in the sixties we couldn’t even accept it. I don’t know if you know the story about how child abuse … battered child syndrome really was became quite prominent. But a radiologist named Henry Kempe in Colorado was trying to discover why some children came in with repeated fractures of their bones. And he was trying to isolate some kind of bone disease. Because the parents and the children didn’t report that the child was being abused. And, over time, he finally realized that these stories are improbable and that some children were being beaten severely by their parents. So, in some ways what research can do is provide evidence that children and parents couldn’t all by themselves … about some of these things. And help us not hide our eyes from some of these things.

A second thing that’s … and science has begun to do that and we can talk more about that if you want. Another thing science can do is help us understand when these things happen, what are their likely affects on development? Why do some children seem to do relatively okay even in the face of adversity. And why some kids don’t.

And then, for me, the most important thing is the action issue. Science can help provide some guidance about what we can do to prevent these problems or to help children recover from them.

HEFFNER: First, “hide our eyes”. That’s an interesting thought. Does it mean that we are not as child centered a society as we’ve always touted ourselves as being?

ABER: I think we are … thou doth protesteth too much …

HEFFNER: Mmmm.

ABER: Yes, we are very child centered in many ways. But in many ways we don’t figure out how to help children because it often means helping parents that we don’t like. And …

HEFFNER: Say that again.

ABER: Ahemm …

HEFFNER: … Or run through that …

ABER: Sure.

HEFFNER: … explain it …

ABER: Sure. In the United States today about one in six children live in families with incomes below the poverty line. Poverty line for a family of four in this country is about $17,000 a year. Not, not a…a grand sum. And, and one in six kids live in, in families with…making that little. Most Americans don’t know that figure. It’s widely available. Most Americans don’t know it. Most Americans assume that… children who are very poor have parents who are unworthy, who… aren’t doing what they need to do. And so, they resist the knowledge that children are in trouble and they resist the, the evidence-based strategies we know about how to help them in part cause they’re angry at the parents and they want to blame the parents. And it takes helping the parents to help the kids.

HEFFNER: This sounds like the Social Darwinism of the 19th century.

ABER: It…I think it’s related to that. I think it has even deeper and more fundamental roots. I think it has to do with America’s preference for understanding things in highly individualistic ways. I think we are a country that … the, the belief that individuals can make it on their own, that…they, we don’t want a nation-state meddling in private family affairs. It…and combined very powerfully to reduce our belief that we can have a community, or collective responsibility for kids that can be exercised in a good way. We … the most recent Welfare Reform Bill was the “Personal Responsibility and Work Opportunity Act”. And certainly there is plenty of personal responsibility that to be part of it. We need a community responsibility part, too. And our fundamental ideology and values I think make it hard to mount some of things we know that work.

HEFFNER: The researches that you do. What are the age groups that you’re concerned about? We talk about children, what do we mean?

ABER: Well, I…I had a professor in college who said that adolescence ended roughly around 30 or 35 …

HEFFNER: If then.

ABER: … If then. And certainly the whole tendency in Western civilization over the last two centuries is to advance the age, extend the age of immaturity. And that sounds bad at first, but in evolution and in human development, the longer the organisms are in a relatively immature state, the more they can learn. And, and so, so there’s a way in which an extended… immaturi