Amherst Magazine

Grappling With Demons

The following is the full text of the presentation delivered by Richard Aronson ’69 during the Reunion panel on mental illness in the family. It was not included in the print version of the magazine because of space limitations. Aronson is the medical director of the Maternal and Child Health program of the Maine Bureau of Health in Augusta.

Striving for Hope

By Richard Aronson '69

The purpose of public health, as defined by the Institute of Medicine, is to foster conditions that will enable the whole population to achieve optimal health. At the center of public health is the human mind and spirit. For children to reach their optimal potential—for children to climb every mountain and soar—they need to:

To have a sense of hope is basic to our capacity to feel healthy, regardless of what we face in our individual and collective lives. We need to nurture and sustain hope, not because of the evidence around us, but because the alternatives—despair, surrender, apathy, and cynicism—are spiritually fatal when they reign supreme.

Human beings can live for roughly 8 to 12 weeks without food, 8 to 12 days without food and water, 6 to 8 minutes without oxygen. But without spirit, a certain kind of death is inevitable in just a few seconds. And so it is that an inscription found on a cellar wall in Germany written by a Jew in hiding from the Nazis contained these words: “I believe in the sun even when it is not shining, I believe in love even when there is no one there, I believe through any trial there is always a way. And I believe in God when God is silent.”

So our challenge as a society is to create and grow systems, both formal and informal, that inspire hope. Instead of systems that repeatedly pathologize and categorize and lump people into a dizzying array of risks, diseases and disorders, we need systems that honor and respect children, families, communities and cultures; that celebrate their strengths, their resiliency, their creativity and their capacity to heal; that do justice to the fact that one of the most important determinants of health is the quality of our relationship and, as research shows, the extent to which we feel connected to each other and to our communities.

Such connections enrich our health and represent a deep well of protection from stresses and adversity. The key public policy questions are: How can we create and grow humane systems of care and public policy that make it easier and more natural for such bonds to form? And how can we design systems that inspire a deep civic engagement, which also is a powerful promoter of health, including mental health? The ways that we choose to respond to these questions will have, ultimately, a significant impact on the health of our democracy.

I have a few thoughts to share in response to these questions.

1. Get rid of arrogance. I don’t have to go farther than myself to give an example of this. For in my profession of medicine, if we don’t understand something, if it doesn’t fit into our particular way of viewing the patient, if we can’t come up with the correct ICD-9 diagnostic code, then we devise all kinds of ways to make it fit. If it doesn’t fit, we conclude that it doesn’t exist. Indeed, it’s rare to find a group that is more intellectually arrogant than people in medicine.

2. Be flexible. In my field of child and family health, we should be flexible enough to humanely respond to the needs and the strengths of families; we should be flexible in our expectations. We expect children to move in the same way, to think in the same way, to act in the same way, and when they don’t, we say that there’s something wrong with them. We ought to pay more attention to the practice of flexibility. Blessed are the flexible, for they will never be bent out of shape.

3. Humor and play. Our children have a gifted resistance to the wide variety of boxes that we adults design for them. They tap into the wisdom and lightness of their playful nature. They know the beneficial effects of laughter and how humor and health go hand in hand. For example, a six-year-old averages 300 laughs in a day, in contrast to the adult average of 15 to 100. Let’s use all of our gifts, including those that we as children had at our disposal, to create humane systems for families. Let’s laugh more, play more, create more. All are central to humane systems.

4. Include families. Jacqueline Kennedy Onassis stated, “If you bungle raising your children, I don’t think whatever else you do in life matters very much.” Let’s give out the message that raising our children well is the most important of all occupations. Families who do well in this great job should be viewed as scholars of experience. They are in for the long term. They have their doctorates in perseverance. Raising children is an enormous and humbling challenge that takes us to the core and to the brink of our human-ness, even in optimal circumstances. It’s not an issue that affects only some other group of people whom we choose to identify as high risk. Including families from start to finish in the design of humane systems is essential.

5. Give people a voice. Let’s recognize that all people have expertise, not just a selected few who stand at a lectern and give Power Point presentations. Let’s aim to let go of the degrees and titles after our names out of respect to our shared humanity. And let’s give everyone a voice in the systems that affect their lives, especially those who have been historically marginalized. Such a paradigm (“par-a-digem,” as we say in Maine) requires a focus on whole-systems change in a world, as Martin Luther King Jr. said, where “we must learn to live together as brothers and sisters or we shall perish together as fools.” We can and should listen more deeply to each other, for such listening is essential for personal and collective healing and justice.

6. Risk. We’re challenged to take risks to spark dialogue and action, for, as the theologian Paul Tillich wrote, “He who risks and fails can be forgiven, (but) he who never risks and never fails is a failure in his whole being.” To have this session on mental illness today involved taking a risk.

7. Art. Let’s honor the artists within society as well as the artist within ourselves. As President John Kennedy said here in 1963 when breaking ground for the Robert Frost Library, “When power leads man toward arrogance, poetry reminds him of his limitations. When power narrows areas of man’s concern, poetry reminds him of the richness and diversity of his existence. When power corrupts, poetry cleanses.”

8. Resiliency.  Our services have historically focused on deficits and risks. We hear families cry out (as my family has) for systems that show respect for the dignity and skill with which a majority of them survive and thrive in spite of often-overwhelming stress. Most do a lot better than we may rush to judge. Families do not want to be primarily viewed through the lenses of highly charged labels, diagnoses and designations, such as “single parents” and “crack babies.” In fact, many single parents do remarkably well and deserve to be honored for their courage in getting out of abusive relationships to protect and promote their children’s health.

9. Language. The classical language of public health and health care is a throwback to a time gone by. Rooted in bureaucratic jargon such as “needs assessment” and military terms such as “surveillance,” “targeting,” and “intervention,” it represents a striking paradox. It not only fails to capture the essence of our work, but it also has the potential to break down and fracture the trust between our profession and the public that is necessary for our work to make a difference. The challenge is to simplify the language that we use, to clarify it, get rid of bureaucratic jargon and paradoxical acronyms so that it is more humane and more in synch with inspiring hope.  

10. Culture. We need to create humane systems that honor and respect the cultures of all people.

Finally, let’s keep in mind Gandhi’s invitation that “we must become the change we want to see in the world.” 

The “Hymn to Amherst,” composed 50 years ago, is a tender and profound affirmation of hope. The last verse, rewritten to be gender neutral, has the following lyrics:

“In the love of Amherst hearts
Abides her greatest glory
As the future lives again
The old, unchanging story.
Youth and beauty,
Learning, faith,
Bound by friendship’s charter
To the college we have made
With eye and mind and heart.”

I am forever grateful to Amherst and my Class of 1969 for inspiring this never-ending quest for such glory of the heart.