Americans in Sickness and in Health

Americans have an odd mix of attitudes toward questions of health and illness. The national creed proclaims that all works out for the best, that a remedy exists for every ill and that maybe immortality itself is within reach of those with abundant faith and willpower.
05/12/2014 11:54 am ET Updated Jul 12, 2014

Americans have an odd mix of attitudes toward questions of health and illness. The national creed proclaims that all works out for the best, that a remedy exists for every ill and that maybe immortality itself is within reach of those with abundant faith and willpower. Yet, they are obsessed by the latest threats to their wellbeing -- whether they originate in nature, mankind's abuse of the natural environment, or our own out of synch bodies and minds. The faithful find some solace in the conviction that God has a plan for each of us, presumably a benign one. Devout secularists find comfort in the wonders of modern medical science and/or the observance of strict discipline in tending to the inner resources of our psycho-somatic selves.

Many combine all three approaches. To browse the shelves of the local Barnes & Noble is to discover an extraordinary variety of literature devoted to making us feel better. In one Texas store, I counted 127 linear shelf feet of books on Christian uplift for body and soul, '93 linear feet of Wellness and Self-help books, along with 55 linear feet of guides to good health of one sort or another. The last give prominence to a host of new diseases and mental illnesses as well as prescriptive advice. Location in the same section facilitates cross pollination.

The pre-occupation with what ails us, what could ail us, how to avoid them, and how to cure them also has become a staple of social conversation. In all walks of society, from highly educated professionals to modest wage earners, this self monitoring and scrutiny has become standard fare for conversation. So much so that it is on the verge of displacing local real estate prices and gossip about colleagues' salaries as the main topic of verbal exchange. Groups that meet periodically are especially prone to shift into this chronic mode of discourse. For they long since have exhausted any interest in each other's idiosyncrasies and have grown inured to one another's political prejudices. Instead, high levels of animation are generated by a swapping of reports or rumors about the latest takes on high blood pressure, cardiac abnormalities, liver function and more esoteric medical matters which are at the cutting edge of studies in human mortality. In extreme cases, the get-together can turn into an organ-of-the-month seminar series. This phenomenon is by no means restricted to the elderly. Indeed, the achievement of high performance attracts as much interest as do worrisome signs of debilitation.

Hot topics can be the latest Nautilus torture apparatus that has been crafted to address sub-optimal function of some till recently unknown muscle; a variation of Zumba that conjures images of high voltage exhibitions at the half-time show of next year's Super Bowl -- in the event that Beyonce calls in sick; and an innovative school of yoga exercise that has tailored an ancient Vedic formula to meet the specific requirements of those with advanced degrees, subpar spiritual energy, and thriving bank accounts. The last includes a fashion element insofar as the proper yoga pants are crucial to obtaining the maximum benefit from the routine. The design supposedly has been sanctified by a rishi from his ashram on the upper reaches of the Ganges. The shortage of high-end yoga pants last year provoked an acute crisis in the wake of the Bangladesh garment factory collapses which disrupted access to the prized garment. Many a discussion group scaled new heights of soul-searching as participants came to grips with the trade-offs between raising individual self-awareness, on the one hand, and enlightened humanistic concern for the brutalization of Bengali women, on the other.


This recitation of peaks and valleys in the discourse on health and illness risks giving the impression that Americans are absorbed only by their own condition. Their children, too, are under constant scrutiny. After all, there is no point in moving heaven and earth to get your kid into that super pre-school which opens the path to Harvard and eventually the 1% if the child is handicapped by some subclinical ailment of mind and/or body. The latter having become quite rare, the worry centers on the emotional side.

In the old days, things were a lot simpler. The notion of "normal' was a great deal broader and looser. One worried about an offspring's emotional condition only when there were manifest symptoms of a serious mental problem. Of course, the term "neurotic" was freely bandied about -- especially among the educated and/or dutiful readers of certain East Coast publications. Usually, though, neurosis was a condition associated with adults. Furthermore, it was widely viewed as just a personality quirk rather than a crippling illness. Only sophisticates thought in terms of treatment -- whether through psychoanalysis if one had a lifetime of leisure to devote to it, or milder forms of counseling. The vast majority made due without the former. Some received helpful counseling. Almost all managed to get through various well-meaning ministrations without suffering any impairment.

Forty years ago or so, the situation began to change dramatically and irrevocably. To strip a complicated story to its essentials, three factors converged to produce an epochal transformation. Most important was the revolution in psycho-pharmacology. The discovery of the correlation between behavioral traits and chemical states in the brain launched a search for medications that could alter the former by adjusting the latter. Our success in finding them has revolutionized psychiatry and psychology. The benefits have been immense -- especially for those with certain serious mental disorders. Many with more garden variety disorders have also benefited.

Unfortunately, drug therapy has turned into a Frankenstein-like monster. Pharmaceutical companies began aggressively to promote their drugs as treatments for conditions they were not appropriate for- and for ambiguous conditions that deserved no drug intervention whatsoever. They went a step further in funding generously studies, institutes and doctors who found it professionally worthwhile and profitable to generate findings that coincided with the financial interests of the industry. Over-diagnosis became the norm.

Distortion of professional responsibilities was an accompanying phenomenon contributing to the abuse of drug therapy. More and more personality types were identified as "abnormal" and dysfunctional. The standards for diagnosis of a clinical condition were drastically lowered. The inclination to find a behavioral "problem," to declare it in need of treatment, and to prescribe a psycho-pharmacological remedy became endemic. Soon, the country was experiencing an outbreak of emotional problems among its young of enormous proportions. All of this was officially codified in the definitive manuals prepared by the American Psychiatric Association and its affiliates. Attention Deficit and Hyperactivity (hijinks) Disorder (ADHD) is of course the prime example.

The third element in the mix has been a dramatic rise in the anxiety level of parents. Fifty years ago, very few kids were perceived as emotionally disturbed because the measures of normality were less strict -- and because accumulated collective experience told parents that minor behavioral oddities were outgrown as children matured and assumed an adult role in society. It is impossible of course to measure with precision any of these attributions and presumptions. It is noteworthy, though, that the observed evidence of those more-or-less adjusted adults suggests fewer, and less severe behavioral peculiarities visible among the general population than are exhibited by many of our leaders: e.g. narcissism, egomania, delusional fantasizing, chronic mendacity, acute status insecurity, deep sexual compulsions and fears, and kleptomania.

As Professor Allen Frances has reminded us: "Having some psychiatric symptoms is part of the human condition and does not by itself indicate the presence of mental disorder."

We all have our anecdotal memories. Surveying mine, I can recall only one classmate who exhibited traits that suggest ADHD. That is one of 150 through middle school. Today's official statistics put the percentage at about 11% (16 of 150). This was at schools free of corporal punishment or indoctrinated fear of Hellfire or other harsh mechanisms of social control.

With the battle over ADHD still raging, a new menace to parental peace of mind has arrived. It is called "Sluggish Cognitive Tempo." Its emergence follows the trail blazed by ADHD and attendant drug treatments almost precisely: dire reports of its incidence, the appearance of a wonder drug -- available soon at a pharmacist near you, and endorsement by credentialed psychiatrists. The claimed symptoms of this new syndrome include: daydreaming, listlessness and slow mental processing. Its proponents estimate that SCT afflicts approximately two million children -- for starters.

These traits are even more obscure and harder to pin down than those supposedly indicative of ADHD. A state of dreamy inertia may have many, innocuous causes, inter alia, poor sleep due to loud parental rows over which workout apparatus to buy; vivid imaginings of the Mets finally signing a free agent who might make a difference; boredom induced by an English teacher who just discovered the retro delights of Silas Marner; or being entranced by the play of sunlight on the autumn leaves outside the window. Admittedly, there may be a consequent learning price to pay in missing something going on in the classroom. There are benefits, though.

When these children grow up, most will have to learn how to cope with intense boredom in collective settings. Committee meetings are a feature of contemporary life. So are workshops. And if you excel at these, you may find yourself in the mind and soul-numbing environment of a "retreat." SCT could be an asset on those occasions with positive effects on career advancement. It is a proven asset even at the very top.

President Jacques Chirac of France was notorious for his inattentiveness when attending heads of government meetings of the European Union. The dreary subject of agricultural policy in particular was guaranteed to generate sedative tedium. Chirac's antidote was to bring along the latest Sotheby's auction catalogue for Chinese ceramics which he would place below table top level and peruse contentedly while his 27 colleagues droned on about rape seed subsidies. He did take the precaution of instructing a ministerial colleague: "tell me when they reach Denmark." If Chirac as a child had been dosed with mood altering drugs to suppress his aptitude for disengagement, it might have changed the course of European history. Whether he would have found a career as a Jazzercise instructor more gratifying is another matter.

As for school kids, they are too tightly policed to enjoy the luxury of glancing at The Onion on their laps. That is all the more reason for them to cultivate a talent for dozing with their eyes half open. It may be one of the truly valuable and lasting practical skills that they take away from their long -- often dreary -- years of education.

There is a bigger issue. Today, to be free of emotional oddities can be a handicap -- for the behaviors of public figures noted above evidently are not a disability but an asset. These are the counter-Chirac examples which exist in abundance. Let's face it: those and other warped behaviors have become so pervasive in professional and public circles generally that an ordinary person of talent and integrity might actually recoil at the prevailing ethos. They may find the worlds of finance, politics and a number of the liberal professions, too, alien. Even the celebrated brainy world of Silicon Valley and its imitators is largely a playpen for immature egoists whose inflated self importance more than matches their I.Q.s. These last mentioned -- the brave buccaneers of the electronic frontier -- fear only one thing: being forced to grow up. Grown-ups, therefore, are to be shunned. The rabid ageism of the electronic frontier has nothing to do with diminished creative powers or flagging enthusiasm. Rather, it is the tangibly present adult experience of life that makes the juvenile prodigies so uneasy. (See the graphic depiction in 'Silicon Valley's Youth Problem' by YIREN LU NYT Magazine March 16, 2014). Hence, estrangement and shunning is the price to be paid for opting out of the game of "more turbo-charged than thou."

Distraught at the prospect of your children being marooned on an island of mature "normalcy" bereft of glamor and great riches? Douse your kids with SCT medications and turn up the Zumba music -- and don't forget the yoga pants.