Nine - A WALK IN THE SHADOWS
Nine
A WALK IN THE SHADOWS
HOW CULTURE BLINDS US TO THE WAYS OF LOVE
It is difficult to get the news from poems yet men die miserably every day for lack of what is found there.
—William Carlos Williams
The evolution of the limbic brain a hundred million years ago created animals with luminescent powers of emotionality and relatedness, their nervous systems designed to intertwine and support each other like supple strands of a vine. But in life, as on the Greek stage, every attribute confers a matching vulnerability; each heroic strength finds its mirror image in a tragic flaw. So it is with the neural skills that constitute emotional life. The limbic brain bestows experiential riches denied simpler creatures, but it also opens mammals up to torment and destruction. An alligator never feels the pain of loss, and a rattlesnake never suffers illness or death upon separation from its parents or progeny. Mammals can and do.
The neural structures responsible for emotional lives are not infinitely adaptable. Just as the dinosaur body was built to live within a range of temperature, so the limbic brain chains mammals to a certain emotional climate. The giant reptiles vanished when the skies darkened and temperatures fell. Our downfall is equally assured if we push our living conditions beyond the limits our emotional heritage decrees.
Because our minds seek one another through limbic resonance, because our physiologic rhythms answer to the call of limbic regulation, because we change one another’s brains through limbic revision—what we do inside relationships matters more than any other aspect of human life. We can conduct marriages, raise children, and organize society in whatever manner we decide. Every choice (to varying degrees) suits or flouts the heart’s changeless needs. An apparently straightforward and rewarding course of action can ramify into emotional predicaments that no one would deliberately select. People vary in their awareness of emotional imperatives. Those who grasp them live better lives; those who do not suffer inexorable consequences.
The same is true of larger societies. Cultures transform themselves in a few decades or centuries, while human nature cannot change at all. The likelihood of collision between cultural dictates and emotional exigencies is significant. Some cultures encourage emotional health; others do not. Some, including modern America, promote activities and attitudes directly antithetical to fulfillment.
Instead of protecting us from the frailties of the limbic brain, American culture magnifies them by obscuring the nature and need for love. The price for that failure is high. Every solid object casts a shadow, and the architecture of the emotional mind is no exception. The human heart is an early morning avenue, one half a sunny promenade where lovers walk and children play, the other side draped in velvet shade. Flowers of sadness and tragedy, and occasionally evil, grow on its darker side.
KIDS THESE DAYS
An infant does his best to keep parents close: he gazes and burbles when they are near, waves and clutches if they move away, and wails into the vacuum of their absence. The infantile arsenal of enticement typically meets with unparalleled success. In a baby, parents find both miniature tyrant and artful enchanter—his tiny burps and grunts arouse bustling concern; his contentment imparts parental bliss. A baby’s ability to keep parents beside him has evolved not to serve whim but limbic necessity. Eons of experience direct his brain to hold open the emotional channel that stabilizes his physiology and shapes his developing mind.
From the first hours of life, Americans traditionally sever this connection at night. Our culture assumes that a baby shouldn’t sleep with his parents.
The issue of an infant’s nocturnal location is reverberating around the national consciousness, thanks to the awakening of a fractious debate. Many American pediatricians frown upon cosleeping. Dr. Spock warned against the practice decades ago in his monumentally influential volume, Dr. Spock’s Baby and Child Care. “I think it’s a sensible rule not to take a child into the parents’ bed for any reason,” he wrote. Spock had a lighter touch than pediatrician Richard Ferber, who has waged a veritable crusade against the idea of parents and young children sharing a room or a bed.
Ferber relies on Freud’s questionable habit of attributing to infants and toddlers an adult awareness of swirling sexual motives. Young children, Ferber declares, find parental sleeping accommodations “overly stimulating.” He goes on to intone: “If you allow him to crawl in between you and your spouse, in a sense separating the two of you, he may feel too powerful and become worried. . . . He may begin to worry that he will cause the two of you to separate, and if you ever do he may feel responsible.” The mistake here is “adultomorphism”—presuming that children are grown-ups viewed through the wrong end of a telescope: tiny, mute, fully outfitted with mature sensibilities and concerns. If a baby thought like a twenty-year-old, then perhaps he would suffer the ailments that, for Ferber, incontrovertibly follow a night in bed with his folks: confusion, anxiety, resentment, guilt.
On the other side of the aisle are evolutionary psychologists and cross-cultural sociologists, who point out that the American habit of sleeping separately is a global and historical singularity. Almost all the world’s parents sleep with their children, and until the last sliver of human history, separate sleep was surpassingly rare. The burden of proof thus falls upon our culture to justify its anomalous nighttime practices. Robert Wright, a prominent proponent of evolutionary psychology and a champion of common sense, refutes Ferber:
According to Ferber, the trouble with letting a child who fears sleeping alone into your bed is that “you are not really solving the problem. There must be a reason why he is so fearful.” Yes, there must. Here’s one candidate. Maybe your child’s brain was designed by natural selection over millions of years during which mothers slept with their babies. Maybe back then if babies found themselves completely alone at night it often meant something horrific had happened—the mother had been eaten by a beast, say. Maybe the young brain is designed to respond to this situation by screaming frantically so that any relatives within earshot will discover the child. Maybe, in short, the reason that kids left alone sound terrified is that kids left alone naturally get terrified. Just a theory.
As Wright acknowledges, many features of the modern world, while unnatural, are not necessarily harmful. Central heating, frequent bathing, and reading glasses come to mind. Are sleeping arrangements another modern choice, neutral with respect to health? Ferber warns that the desire to share a family bed is a psychological oddity that may necessitate “professional counseling” to resolve. To support his claim, he offers recycled Freudian hash but no facts. The work of sleep researchers, however, has raised the possibility that separate sleep itself entails physiologic risk.
A baby may die suddenly and quietly asleep, and without evidence of trauma or illness, as if the soul so freshly deposited in that diminutive form was not quite fixed in place and slipped out to return to the spirit world. What parents formerly feared as crib death goes by the name sudden infant death syndrome, or SIDS. The syndrome remains mysterious. A few cases have been reclassified as covert homicides, but in the vast majority of SIDS deaths, no physical or environmental abnormality can be found. Disparate rates in different societies, however, point to a cultural contribution. Despite its advanced medical technologies and sophisticated pediatric care, the United States has the highest incidence of SIDS in the world: two deaths for every thousand live births—ten times Japan’s rate, and one hundred times Hong Kong’s. Yet in some countries the syndrome is virtually unknown.
Sleep scientist James McKenna and his colleagues conducted an unprecedented study that may shed light on the mystery of SIDS. They studied how babies sleep in the environment prepared for them over millions of years of hominid evolution—maternal proximity. McKenna found that a sleeping mother and infant share far more than a mattress. Their physiologic rhythms in slumber exhibit mutual concordances and synchronicities that McKenna thinks are life-sustaining for the child. “The temporal unfolding of particular sleep stages and awake periods of the mother and infant become entwined,” he writes. “On a minute-to-minute basis, throughout the night, much sensory communication is occurring between them.” Paired mothers and infants spend less time in sleep’s deepest stages and have more arousals than their solitary counterparts— neural changes that, McKenna feels, protect infants from the possibility of respiratory arrest. Cosleeping infants breast-fed three times as much as solo ones and were always in the supine position, both factors that also protect against SIDS. Small wonder that the human societies with the lowest incidence of SIDS are also the ones with widespread cosleeping. The sleep separatists exhumed the Pavlovian attitude toward children that dominated psychology early in the last century. Reward a child’s distress with attention, they said (and say today), and you increase the probability of recurrence. A child left alone at night, with no human presence to “reward” him, eventually stops crying and makes do without. But sleep is not a reflex, like the canine salivation a flank steak provokes. The dozing adult brain rises and descends through half a dozen distinct neural phases every ninety minutes, in gradually lengthening symphonic movements that culminate in morning wakefulness. Sleep is an intricate brain rhythm, and the neurally immature infant must first borrow the patterns from parents.
Infants are born knowing this—the typical baby, whether placed on his mother’s left or right, spends the entire night turned toward her, with ears, nose, and occasionally eyes drinking in the sensory stimulation that sets his nocturnal cadences. The same principle allows a ticktocking clock to regularize the restless sleep of puppies newly taken from their mother, and enables the breathing teddy bear to stabilize the respirations of preemies.
Although it sounds outlandish to some American ears, exposure to parents can keep a sleeping baby alive. The steady piston of an adult heart and the regular tidal sweeps of breath coordinate the ebb and flow of young internal rhythms. Intuitive accordance with these ancient programs leads women, whether right- or left-handed, to cradle a baby in the left arm—with his head close to her heart. That laterality cannot be custom or cultural predilection, because gorillas and chimpanzee mothers show the same, innate, left-sided cradling.
The family bed debate dances around an American conundrum: we cherish individual freedoms more than any society, but we do not respect the process whereby autonomy develops. Too often, Americans think that self-rule can be foisted on someone in the way a traveler thrusts a bag at a bellhop: compel children to do it alone, and they’ll learn how; do it with them and spawn a tentacled monster that knows only how to cling. In truth, premature pressure stunts the genuine, organic capacity for self-directedness that children carry within them. Independence emerges naturally not from frustrating and discouraging dependence, but from satiating dependence. Children rely heavily on parents, to be sure. And when they are done depending, they move on—to their own beds, houses, and lives.
A dog possesses no instinct to stay off the couch; if you wish him to abandon the comfort of plush pillows, you have to train him. A rat has no intrinsic desire to run a maze, but the right combination of lures and punishments can make him do so. Children need no forcing or foot shocks or food pellets to instill independence. “The one thing in the world of value,” Emerson observed, “is the active soul—the soul free, sovereign, active. This every man is entitled to; this every man contains within him, although in almost all men, obstructed, and as yet unborn.”That second effusion of life is the work of childhood; love and security are the patient midwives whose ministrations bring forth a new soul.
Doctors once told American women that breast-feeding was an archaic perversion. After technology produced safe and convenient bottles, mothers who wanted an infant at the breast were thought backward and probably pathologic. Now we know that natural feeding suits a baby’s needs as no artificial substitute can. The ratio of nutrients in her milk agrees with his metabolism, and the antibodies she transfers during feeding confer lifesaving immunity against disease. Medical opposition to breast-feeding is a historical relic. This generation of mothers labors under an equally dubious pronouncement—that babies sleep best in isolation. Every infant knows better. His protest at nocturnal solitude contains the wisdom of millennia.
Surpassing the acrimonious disagreement about how to care for young children at night is the explosive conflict over the proper disposition of their daytime hours. A factual kernel is the only consensus item: young American children once spent most of their days with their mothers, and many no longer do. A spectrum of surrogates occupy modern babies and toddlers: relatives, live-in au pairs, regular or revolving nannies, neighbors, institutional day care workers, television shows, Disney videos, interactive computer games. Does it make a difference with whom a young child passes his time? So long as his attention is occupied and he keeps out of harm’s way, does it matter whether his caretaker is a parent, a grandmother, a nanny, a stranger, an electronic device?
These questions revolve around an inconvenient center of gravity: the specificity of a child’s limbic needs. If he wants only respite from boredom, any colorful distraction suffices; if he requires just the reassurance of a protective presence, any adult will do. But decades of attachment research endorse the conclusion that children form elaborate, individualized relationships with special, irreplaceable others. Investigations into the biology of that bond suggest that its preciousness emerges from neural synchrony between child and parent, and that adult neural patterns will impress themselves on a malleable brain. If so, then some of the situations in which our children currently dwell will not produce the same result as the luxuriously prolonged immersion within a small circle of devoted caretakers.
A child’s electronic stewards—television, videos, computer games—are the emotional equivalent of bran; they occupy attention and mental space without nourishing. An ironic revelation of the television-computer age is that what people want from machines is humanity: stories, contact, and interaction. (Nature took a few billion years to create that kind of mechanism from scratch, so perhaps we should not wait for Silicon Valley to produce one any time soon.) Today’s machines deliver not a limbic connection but imprecise simulations. Small wonder that Internet use in adults actually causes depression and loneliness. “We were surprised to find that what is a social technology has such anti-social consequences,” said that study’s author. However enticing their entertainment value, mechanical companions are unworkable relationship substitutes for adults and children alike.
Next to the role of a child’s human companions. The amount and quality of love a child receives have long-lasting neural consequences. The evidential support for these contributions continues to grow brick by empirical brick: an emotional void often proves fatal to babies. Neglect produces children whose head circumferences are measurably smaller, whose brains on magnetic resonance scanning evidence shrinkage from the loss of billions of cells. Children whose mothers are depressed early in life evidence persistent cognitive deficits. Twenty years of longitudinal data have proven that responsive parenting confers apparently permanent personality strengths. Primate rearing studies have detailed the neural devastation that follows early isolation, as well as the subtler derangements that persist in a young monkey’s brain from placing his mother under emotional stress. Even young rats receiving more nurturance have better developmental trajectories than their less-coddled littermates. The unimpeachable verdict: love matters in the life of a child.
All of us are born with limbic machinery running soundlessly behind wide eyes. The crucial question—just how much flexibility does that system permit? No one knows for sure. The mere presence of a single, constant caretaker cannot ensure health, since an optimal parent has to be capable and attuned. Not everyone is. With multiple caretakers, the problem divides: first, how good is each at tuning in to the child and regulating him? Second, when do the unavoidable discontinuities of serial caretakers prove incompatible with instilling emotional stability?
Parents and relatives wield an obvious advantage in the quality department: their exertions are spontaneous labors of love. Some nannies and day care workers feel a genuine and abiding fondness for the children they supervise. Even so, their affection does not rival parental passion. With rare exceptions, other people’s children simply do not elicit the same reckless, selfless devotion that one’s own offspring naturally evoke. If child care jobs commanded lavish salaries (in place of the minimum wage typically doled out), the intrinsic barriers to love would still be formidable. Who but an enthralled parent will attend so closely that he learns all of a child’s subtle cues, picks up on the tiniest signals, and enters into the creation of a personal limbic dialect? Who else will feel the spontaneous ardor, fascination, and patience that are the requisite attendants to every complicated, creative endeavor?
Successful synchrony between two mammals is an acrobatic maneuver wherein each catches another’s rhythms and adjusts his own accordingly. Parent and child are circus jugglers deftly exchanging bowling pins; a stranger cannot smoothly step into their practiced rhythm without disruption. The hard truth is that few employees will feel inspired to love someone else’s child in the fullest sense of the word—and even if they did, the task would be exceedingly difficult. To make matters worse, the average out-of-home care provider faces not the complex emotional requirements of one customer’s child but, at best, three or six at a time. Economies of scale exist for clear reasons, but the impersonal element they inject is anathema to a baby’s developing emotional needs. To paraphrase Mark Twain: the difference between a caretaker who tunes in to a child and one who almost tunes in is as great as the difference between lightning and a lightning bug.
All other things being equal—and sometimes they are not— parents stand the best chance of meeting young limbic needs because of the regularity of their presence and the natural depth of their devotion. Inverting those advantages exposes the shortcomings of institutional day care. An infant’s brain is designed for ongoing attunement with the people predisposed to find him the most engaging of all subjects, the most breathtakingly potent axis around which their hearts revolve. Instead he finds himself competing with half a dozen peers for the emotional focus of an understandably unimpassioned surrogate. Will a parent’s infatuation and the divided attentions of sequential strangers exert a comparable effect on the developing brain? The pull to believe so emanates from wishful thinking rather than the plausibility of the hypothesis itself.
How much affectionate parental momentum does a baby need, then, to keep him coasting through impersonal limbic flatlands? Love is a bodily process and therefore consumes an incompressible amount of time. Each week a child’s extrafamilial hours can range only from 0 to 168, the numerical limits to never and always. Between those temporal bookends, a certain number must exist—call it X hours—where the impact of parental absence shades from negligible into emotional risk.
Most agree that X, varying somewhat from child to child, increases with age—babies need togetherness most, toddlers a bit less, older children still less. For any particular age, where does it fall? Does X equal five, ten, twenty, forty, eighty hours per week? The equation does not lend itself to easy study, owing to the exuberant proliferation of confounding variables and the equally confusing exaggerations and distortions perpetuated by a number of parties to the debate. Several researchers have shown that day care in excess of twenty hours per week for children under a year old increases the risk of insecure attachment and its negative emotional effects. Dissenting studies found that extensive day care inflicts no discernible influence when children receive the high-quality variety: big budgets, competent staff, favorable adult-to-child ratios, low turnover—conditions remote from the actual terms under which out-of-home care operates in this country.
With its high percentage of single-parent families and double-income households, discovering the value of X is a pursuit our culture cannot afford to delay. Unfortunately, the slow road to postponement is precisely the path we are on. Such vitriolic controversy erupted over the initial day care data that it choked off meaningful scientific debate. Psychologist Robert Karen described the difficulty, while gathering material for a book, in getting researchers to voice any audible viewpoint. When day care came up, otherwise voluble scientists went mum, apparently intimidated by political heat. “I wouldn’t have any opinion,” one developmental researcher told Karen (if he doesn’t, who does?), and when the latter pressed him, amended his position from incredible to sadly believable: “I wouldn’t have one for publication.”
All cultures, postdating the advent of science, have protected certain propositions from empiricism’s cold eye because even the possibility of an unfavorable result is deemed unacceptable. In this time and place, our culture promotes as self-evident the notion that employable adults must have jobs and careers, that children do fine with less. The extent of cultural reliance on this cornerstone is unrelated to its ultimate soundness, which the science of some future age will assess. “You can fight for a cause and make it come about,” writes William Gass, “but you can never make an idea come true like a wish, for its truth is—thank heaven—out of all hands.” In modern America, ignorance of the developmental extent of parental love is perilous. Choosing ignorance is begging for trouble. If we ask a parent to consider that modern lifestyles may deprive his child of a vital limbic ingredient, a neural vitamin, an emotional vaccine against later illness—then we risk arousing guilt and distress. If we leave the question alone as untouchable, and parents unknowingly shortchange their children, everyone will feel worse.
These matters are irrelevant to parents without any choice—just as information on optimal diets is useless to those who cannot afford food. But some parents do have some temporal leeway, and others may have more than they think. Many parents, particularly mothers, find it excruciating to leave young children behind for days at a time. Limbic pain of that magnitude should not be dismissed as a trifle without the most careful deliberation, the best possible evidence. Parents who contemplate staying at home to raise children are treated instead to the cultural chorus of well-meaning dissuaders: you’re bright; you’re talented; wouldn’t you rather do something with your time? The implication is clear: love doesn’t accomplish; it does nothing we need done. In its baldest tally of values, our culture automatically equates a dedication to full-time parenting with the absence of ambition. But in what human activity could there possibly be more?
Government is the machine that transforms cultural attitudes into policies. “What a society honors,” wrote Aristotle, “will be cultivated.”We need only glance at our social programs to catch the direction of prevailing winds. On one side, conservatives dismantle welfare so that single mothers must set children aside and return to work—not the labor of raising children, but the real work our culture values and upholds. On the other hand, liberals champion child care initiatives calling for an expansion in institutionalized surrogate care. Caught in the middle, American parenthood is beleaguered, belittled, and besieged.
Because so much of parenthood is giving—time, attention, patience, food, guidance, love—incoming emotional sustenance is indispensable for balance. The presence of two parents is neither unintended superfluity nor mere economic advantage; parents need each other for support and replenishment. And yet in more and more families, one adult bears the lopsided burdens alone. A third of American children grow up in mother-only households; one half will live in a single-parent home before turning eighteen. The outcome of such arrangements is predictable: parents who receive inadequate love have less to give—to anybody, including their children. Psychologist Judith Wallerstein studied families for five years after divorce and found in the children “a dismayingly high incidence of depression” at every point along the way. Divorce’s great danger for children is, she writes, “in the diminished or disrupted parenting which so often follows in the wake of the rupture and which can become consolidated within the postdivorce family.”
Humanity’s limbic ties make any social structure a web of interdependencies, wherein perturbations ripple and reverberate, inward and out. Children cannot bloom in a culture where adults do not cohere long enough so that intact families may support needful hearts. And youngsters who grow up without knowing the fullness of love will be fighting the odds when they mount their own struggle to establish a life bond with another. The emotional fate of children is inextricably bound to the ability of their parents to love one another—a skill that is falling into disrepair.
THE DYNAMICS OF DUOS
Relationships, including romantic ones, are fantastic concatenations of limbic energies. Humanity has had eons to become familiar with these ancient forces, but today it seems we apprehend their essence less than ever. Loving relationships plainly perplex our limbically incognizant culture. Bookstores bulge with so many how-to relationship primers that it seems nobody knows how. That ignorance extracts a painful pound of flesh. “Fathers and teachers,” wrote Dostoyevsky, “I ponder the question, ‘What is Hell?’ I maintain it is the suffering of being unable to love.” Too many of our citizens spend their lives in that purgatory, searching vainly for a redemption that eludes them. What don’t they know? What doesn’t our culture teach them?
The simple equations of love. Like this: relationships live on time. They devour it in the way that bees feed on pollen or aerobic cells on oxygen: with an unbending singularity of purpose and no possibility of compromise or substitution. Relatedness is a physiologic process that, like digestion or bone growth, admits no plausible acceleration. And so the skill of becoming and remaining attuned to another’s emotional rhythms requires a solid investment of years.
Americans have grown used to the efficiencies of modern life: microwave ovens, laser price scanners, number-crunching computers, high-speed Internet access. Why should relationships be any different? Shouldn’t we be able to compress them into less time than they took in the old days, ten or a hundred or a thousand years ago? The unequivocal limbic no takes our culture by surprise. The modern American is genuinely puzzled when affiliations evaporate from inattention. Every new second of togetherness reestablishes the terms of a relationship. But cultural mythology imbues social ties with the clumsy durability of things—once attained, always attainable; once established, easy to get back to weeks, months, years later. The truth is only slightly less dire than the words of playwright Jean Giraudoux: “If two people who love each other let a single instant wedge itself between them, it grows—it becomes a month, a year, a century; it becomes too late.”
Some couples cannot love because the two simply don’t spend enough time in each other’s presence to allow it. Advances in communication technology foster a false fantasy of togetherness by transmitting the impression of contact—phone calls, faxes, e-mail—without its substance. And when a relationship is ailing from frank time deprivation, both parties often aver that nothing can be done. Every activity they spend time on (besides each other) has been classified as indispensable: cleaning the house, catching the news, balancing the checkbook.
Such an existence is too expensive to bear. When launching a life raft, the prudent survivalist will not toss food overboard while retaining the deck furniture. If somebody must jettison a part of life, time with a mate should be last on the list: he needs that connection to live.
Couples do not receive this advice from friends, colleagues, family—their world. Instead they are encouraged to achieve, not attach. Americans spur one another to accomplish and acquire before anything else—our national dream holds that industry leads to a promised land, and nobody wants to miss out on a share of paradise. When consummating a career does not bring happiness—as it cannot—few pause to reconsider their assumptions; most redouble their efforts. The faster they spin the occupational centrifuge, the more its high-velocity whine drowns out the wiser whisper of their own hearts.
When they do get down to relating, Americans find they have been tutored for years in the wrong art. In a dazzling vote of confidence for form over substance, our culture fawns over the fleetingness of being in love while discounting the importance of loving.
A child tunes in to the emotional patterns of parents and stores them. In later life, if he spots a close match, the key slides in the psychobiologic lock, the tumblers fall home, and he falls in love. The accuracy of limbic architecture astounds. In a city of 5 million people, in a country of 270 million, in a world of 6 billion, people pick partners emotionally identical to their predecessors and swoon. In love twists together three high-tensile strands: a potent feeling that the other fits in a way that no one has before or will again, an irresistible desire for skin-to-skin proximity, and a delirious urge to disregard all else. In the service of that prismatic blindfold, in love rewrites reality as no other mental event can. “Whoso loves,” wrote Elizabeth Barrett Browning, “believes the impossible.”
Our society goes the craziness of in love one better by insisting on the supremacy of delectable but ephemeral madness. Cultural messages inform the populace that if they aren’t perpetually electric they are missing out on the pinnacle of relatedness. Every pop-cultural medium portrays the height of adult intimacy as the moment when two attractive people who don’t know a thing about each other tumble into bed and have passionate sex. All the waking moments of our love lives should tend, we are told, toward that throbbing, amorous apotheosis. But in love merely brings the players together, and the end of that prelude is as inevitable as it is desirable. True relatedness has a chance to blossom only with the waning of its intoxicating predecessor.
Loving is limbically distinct from in love. Loving is mutuality; loving is synchronous attunement and modulation. As such, adult love depends critically upon knowing the other. In love demands only the brief acquaintance necessary to establish an emotional genre but does not demand that the book of the beloved’s soul be perused from preface to epilogue. Loving derives from intimacy, the prolonged and detailed surveillance of a foreign soul.
People differ in their proficiency at tracing the outlines of another self, and thus their ability to love also varies. A child’s early experience teaches this skill in direct proportion to his parents’ ability to know him. A steady limbic connection with a resonant parent lays down emotional expertise. A child can then look inside someone else, map an emotional vista, and respond to what he senses. Skewed Attractors impair a person’s ability to love freely and well. His heart’s gaze, in the manner of one whose eyes do not properly focus, will have the unsettling habit of looking beyond and behind the person in front of him. A heart thus displaced falters in its efforts to meet another’s rhythms, to catch another’s tempo and melody in the duet of love.
Because loving is reciprocal physiologic influence, it entails a deeper and more literal connection than most realize. Limbic regulation affords lovers the ability to modulate each other’s emotions, neurophysiology, hormonal status, immune function, sleep rhythms, and stability. If one leaves on a trip, the other may suffer insomnia, a delayed menstrual cycle, a cold that would have been fought off in the fortified state of togetherness.
The neurally ingrained Attractors of one lover warp the emotional virtuality of the other, shifting emotional perceptions— what he feels, sees, knows. When somebody loses his partner and says a part of him is gone, he is more right than he thinks. A portion of his neural activity depends on the presence of that other living brain. Without it, the electric interplay that makes up him has changed. Lovers hold keys to each other’s identities, and they write neurostructural alterations into each other’s networks. Their limbic tie allows each to influence who the other is and becomes.
Mutuality has tumbled into undeserved obscurity by the primacy our society places on the art of the deal. The prevailing myth reaching most contemporary ears is this: relationships are 50-50. When one person does a nice thing for the other, he is entitled to an equally pleasing benefit—the sooner the better, under the terms of this erroneous dictum. The physiology of love is no barter. Love is simultaneous mutual regulation, wherein each person meets the needs of the other, because neither can provide for his own. Such a relationship is not 50-50—it’s 100-100. Each takes perpetual care of the other, and, within concurrent reciprocity, both thrive. For those who attain it, the benefits of deep attachment are powerful—regulated people feel whole, centered, alive. With their physiology stabilized from the proper source, they are resilient to the stresses of daily life, or even to those of extraordinary circumstance.
Because relationships are mutual, partners share a single fate: no action benefits one and harms the other. The hard bargainer, who thinks he can win by convincing his partner to meet his needs while circumventing hers, is doomed. Withholding reciprocation cripples a healthy partner’s ability to nourish him; it poisons the well from which she draws the sustenance she means to give. A couple shares in one process, one dance, one story. Whatever improves that one benefits both; whatever detracts hurts and weakens both lives.
Modern amorists are sometimes taken aback at the prospect of investing in a relationship with no guarantee of reward. It is precisely that absence, however, that separates gift from shrewdness. Love cannot be extracted, commanded, demanded, or wheedled. It can only be given.
A culture wise in love’s ways would understand a relationship’s demand for time. It would teach the difference between in love and loving; it would impart to its members the value of the mutuality on which their lives depend. A culture versed in the workings of emotional life would encourage and promote the activities that sustain health—togetherness with one’s partner and children; homes, families, and communities of connectedness. Such a society would guide its inhabitants to the joy that can be found at the heart of attachment—what Bertrand Russell called “in a mystic miniature, the prefiguring vision of the heaven that saints and poets have imagined.”
The contrast between that culture and our own could not be more evident. Limbic pursuits sink slowly and steadily lower on America’s list of collective priorities. Top-ranking items remain the pursuit of wealth, physical beauty, youthful appearance, and the shifting, elusive markers of status. There are brief spasms of pleasure to be had at the end of those pursuits—the razor-thin delight of the latest purchase, the momentary glee of flaunting this promotion or that unnecessary trinket—pleasure here, but no contentment. Happiness is within range only for adroit people who give the slip to America’s values. These rebels will necessarily forgo exalted titles, glamorous friends, exotic vacations, washboard abs, designer everything—all the proud indicators of upward mobility—and in exchange, they may just get a chance at a decent life.
TRUTH AND CONSEQUENCES
Just before the stroke of midnight, while Ebenezer Scrooge is having his last discussion with the Spirit of Christmas Present, he spies two skeletal figures huddling under the latter’s green robes. They are the two children of Man, the Spirit tells him, Ignorance and Want. Appalled at their pitiful and cadaverous condition, Scrooge demands to know what can be done for them. “Have they no refuge or resource?” he cries. The Spirit counters: “Are there no prisons?” he asks, skewering Scrooge with his own miserly incantation against beggars. “Are there no workhouses?” The clock strikes twelve, and Scrooge faces his last and least forgiving ghost, the specter of things yet to come.
Like those who made Scrooge recoil, the dark children of our age are difficult, even painful to look upon. When a society foils limbic mechanisms, it unleashes a string of afflictions whose pathognomonic patterns are part of daily American life.
WHEN THE CENTRE CANNOT HOLD
Without rich limbic resonance, a child doesn’t discover how to sense with his limbic brain, how to tune in to the emotional channel and apprehend himself and others. Without sufficient opportunity for limbic regulation, he cannot internalize emotional balance. Children thus handicapped grow up to become fragile adults who remain uncertain of their own identities, cannot modulate their emotions, and fall prey to internal chaos when stress threatens.
Anxiety and depression are the first consequences of limbic omissions. The dominant emotion in early separation’s protest phase is nerve-jangling alarm. If isolation stretches out, a mammal descends into lethargic despair, depression’s alter ego. Emotional disconnection produces young rhesus monkeys who suffer a lifelong vulnerability to the twin aboriginal states of nervousness and depression; the same is true in our own primate society. Close early relationships instill a permanent resilience to the degenerative influence of stress, while neglect sensitizes children to those effects. The brains of insecurely attached children react to provocative events with an exaggerated outpouring of stress hormones and neurotransmitters. The reactivity persists into adulthood. A minor stressor sweeps such a person toward pathologic anxiety, and a larger or longer one plunges him into depression’s black hole.
These two emotional states are epidemic. Depression and anxiety each cost America more than $50 billion per year, colossal sums that only hint at the mountain of suffering behind them. And the mountain is growing: the rate of depression in the United States has been rising steadily since 1960. Suicide rates for young people have more than tripled over that time; killing oneself is now a leading cause of death in adolescence. Reports on child welfare detail their nutritional status, their lead exposure, the design of the straps in their car seats, but omit mention of the stability and quality of love in their lives. We would be wise to pay as much attention to those relationships as we do to the vegetable content of school lunches.
A person who lacks a stable center feels an urgent need to fill the gap—he needs something to orient himself as he tries to navigate the world. Since he cannot use the limbic tools that penetrate to the core of self and others, he will look to external cues—those he can be sure about. Thwarted attachment and limbic disconnection thus encourage superficiality and narcissism. People who cannot see content must settle for appearances. They will cling to image with the desperation appropriate to those who lack an alternative. In a culture gone shallow, plastic surgery supplants health; photogenicity trumps leadership; glibness overpowers integrity; sound bites replace discourse; and changing what is fades before the busy label-swapping of political correctness. When a society loses touch with limbic bedrock, spin wins. Substantive aspirations inevitably suffer.
If the attachment fabric of a civilization frays, if people cannot get from their relationships the emotional regulation that those bonds were designed to furnish, they will commandeer whatever means of limbic modulation they can lay hands on. Their hungering brains will seek satisfaction from a variety of ineffectual substitutes—alcohol, heroin, cocaine, and their cousins. As a society produces more people who lack access to the neural process that engenders emotional balance, the ranks of street drug users will grow.
Periodic media dispatches keep us posted about the status of America’s war on drugs. But the real battle our country fights is not against drugs per se but limbic pain—isolation, sorrow, bitterness, anxiety, loneliness, and despair. Our culture is losing this struggle so badly that millions try to manipulate the delicate organs of emotion into delivering a respite from their daily dysphoria. If these pharmacologic experiments met with success—if they actually increased happiness and emotional fulfillment—who could object? But homespun chemical remedies for emotional pain are disastrous. Mood-altering agents sold on the street obliterate anguish for a few minutes or hours, and then they dissipate, leaving behind a deeper ache. Repeated use ravages the nervous system and undermines already desperate lives.
America’s antidrug czars have encouraged us to believe that addiction exists because street drugs fasten on to the average mind like the giant kraken of seafaring legend: one tangential brush with this vile sucking beast and a healthy kid’s mind disappears into the black depths forever. The evidence refutes this notion. Contemporary chemists (some in basements and barns) have concocted potent pharmacological snares and have enhanced the power of native ones. But examine the figures for cocaine, thought to be the most powerfully addictive substance known. Of all humans who try cocaine, less than 1 percent become regular users—the other 99 walk away. As Malcolm Gladwell has argued, this staggering imbalance points to a problem not in the juices of coca leaves, but inside the brains of the tiny fraction who find its effect on their emotions irresistible. America expends billions to protect our borders against the influx of small packets of limbic anesthesia. Those sums might be better spent ensuring that our children harbor brains minimally responsive to such agents.
Inherited temperament can facilitate both the willingness to try drugs and the ease of becoming dependent upon them. Neuroscience may someday offer a remedy; other than funding basic research, the average citizen can do little about that end of the problem. But research also indicts nurture, nature’s coconspirator in all neural matters, in modulating children’s vulnerability to drugs. Study after study has shown that children with close familial ties are far less likely to become entangled in substance abuse. Even under ideal circumstances, teenage years abound in emotional surges, changing roles, growing pains. If adolescents do not receive limbic stability from relationships in the home, they will be measurably more susceptible to chemical options outside.
Debates on solving America’s drug epidemic typically alternate between conservatives demanding longer prison sentences and liberals calling for more treatment programs. Both sides are reluctant to admit that neither approach has come anywhere near to ridding this country of our gargantuan problem. Consigning users to a penal system that combines a plentiful supply of drugs and the incentive to use them is not a convincing prescription for amelioration. Treating addiction has proved substantially more effective, when legislators are in a mood to fund it—and, since addicts lack lobbyists, that is not very often.
Cultural awareness of limbic principles informs the kind of measures we expect to prevail in the war on drugs. Will lectures on the evils of chemical dependency deter teenagers from a life of substance dependence? Don’t believe it. While their end is worthy, such talk targets the neocortical brain, not the limbic one. Pain is too potent a motivator for facts to undo. Pretending otherwise is a threadbare illusion convincing only to those who already feel basically well. The insouciance of Just Say No assumes that the human brain and will are separable. They are not. Limbic instability undermines the neural capacity for resolve that jaunty slogans call upon.
An addict’s bulwark against relapse involves more communion than cogitation, as Alcoholics Anonymous and its multiple variants demonstrate. Gathering like people together to share their stories imbues a wordless strength, what Robert Frost called in another context “a clarification of life—not necessarily a great clarification, such as sects and cults are founded on, but a momentary stay against confusion.” The limbic regulation in a group can restore balance to its members, allowing them to feel centered and whole. But even the solidity of the omnipresent clan is no panacea. Too often users return to the ephemeral reprieve that drugs offer.
Incarceration and treatment have their shortcomings. Prevention is the ringing alternative—not television ads and exhortatory pamphlets, but the precious prophylaxis that nature provides, in the form of a family’s early love. Raising children attentively, thoroughly, and patiently immunizes their brains against stress like Salk’s potion protects their bodies from polio. Love is and will always be the best insurance against the despair for which street drugs are the obvious antidote.
LIMITED PARTNERSHIP
The limbic brain makes mammals as ready to fasten to their fellows as LEGO blocks. People form lasting attachments to a variety of others: husbands, wives, children, friends, alma maters, the baseball team nearest their home, the corporation they work for. Who hasn’t felt the twinge of loyalty to an old car when it comes time to sell, or to a pair of jeans past their prime? Like Lorenz’s goslings, people sometimes bond to objects incapable of reciprocating. Detached from human relationships, limbic proclivities can hobble. If a person’s brain targets an emotionally inert would-be partner, attachment needs can propel him into contact with what cannot satisfy him, like a moth battering its wings against a street-lamp in the soft summer night. Mammals can see a deceptive light inside the inanimate, a false attachment wherein the inferred give-and-take never materializes.
Today’s most treacherous false attachment springs up between human beings and corporations. In this era of downsizing and its euphemistic equivalents, the tale of the dedicated worker abruptly terminated after years of loyal service has become archetypal. Behind the stark outlines of the tale are thousands of people who pour their hearts into jobs, give beyond their monetary recompense out of team spirit, and later are unceremoniously dumped. Many such people are waylaid by the attachment mechanisms that should promote well-being but trap them instead.
Natural limbic inclinations include loyalty, concern, and affection. “When you love,” wrote Ernest Hemingway, “you wish to do things for. You wish to sacrifice for. You wish to serve.” Within their designed environment—a family—these impulses make fertile ground wherein healthy relatedness takes root and grows. The workplace bears strong resemblance to the home—indeed, for most of humanity’s history, the work environment was the home. In both settings, one encounters amiable companions, authoritative overseers, shared travails.
A great divide, however, separates corporation and kin. Attachment urges prompt exploitation because companies do not have emotional impulses, and human beings do. A company has no limbic structure predisposing it to recognize its own as intrinsically valuable. People who extend fidelity and fealty to a corporate entity—legally a person and biologically a phantom—have been duped into a perilously unilateral contract.
Steeped as they are in limbic physiology, healthy people have trouble forcing their minds into the unfamiliar outline of this reptilian truth: no intrinsic restraint on harming people exists outside the limbic domain. Preparing soldiers for combat involves not only teaching them physical skills necessary to vanquish opponents but also indoctrinating the emotional outlook that creates an Enemy. That psychological goal is achieved by severing mental bonds between Us and Them while simultaneously strengthening intragroup ties. The Enemy is not like us, both sides tell prospective combatants, they are subnormal, inhuman, less than animals. The average infantryman fights not for lofty political ideals, but because homicidal fiends threaten him and the family of buddies with whom he has labored, suffered, and loved. History brims with the brutality that flows between groups when no limbic tie unites them.
Corporate malfeasance shocks many, but corporations operate outside attachment as surely as armies do. Misdeeds—even savagery—are inevitable. When the tobacco industry delivers death more efficiently than any war machine in history, it does so to our own people—because our own is a limbic, not a corporate, precept. When the Johns Manville Corporation covered up the lethal effects of asbestos, the company sent to their unknowing deaths not strangers, but hundreds of their employees. Any reptile would have done the same. Assuming mutuality where none exists is a mammal’s grave and occasionally fatal error. In the Manville litigation, Charles H. Roemer, former chairman of the Paterson Industrial Commission, recounted a luncheon meeting he had with Manville’s president, Lewis Brown, and his brother Vandiver Brown, Manville’s corporate attorney. The latter ridiculed other asbestos manufacturers for their foolishness in notifying workers about the terminal illness they had contracted on company time. Mr. Roemer’s testimony: “I said, ‘Mr. Brown, do you mean to tell me you would let them work until they dropped dead?’ He said, ‘Yes. We save a lot of money that way.’ ”
The urge to embed oneself in a family—to hold an endeavor in common with others, to be part of a team, a band, a group that struggles together toward a common victory—is an indomitable aspect of the human mind and brain. In a culture whose members are ravenous for love and ignorant of its workings, too many will invest their love in a barren corporate lot, and will reap a harvest of dust.
ALL WE NEED OF HELL
Because limbic regulation between parent and child directs neurodevelopment, social contact is necessary for evolving pieces of behavior to assemble into a functioning animal. Without parental guidance, neurochemical disjunctions accumulate and budding behaviors conglomerate into a mess. Isolation-rearing in rhesus monkeys produces a nightmarish head-banging, eye-gouging mutant with scant resemblance to a healthy, coherent organism. Rhesus monkeys must be mothered even to eat or drink in the normal simian style.
Primate experiments in isolation-rearing have lessons to teach us. Aggression is a formidably complex behavior requiring precise neural control—too little hostility impairs individual survival and too much prohibits the successful cohabitation that social animals crave. In rhesus monkeys nurtured by parents, neuroscientists have established correspondences between aggressivity and brain levels of coordinating neurotransmitters. A normal brain hums with thousands of these subtle rhythms, as microscopic machinery composes and harmonizes behaviors. Monkeys deprived of early limbic regulation have lost both neural organization and the capacity for modulated aggression. They are erratically, unpredictably, chaotically vicious. The condition is irremediable, even with the benefit of today’s advanced neural pharmacopoeia. Gary Kraemer makes the chilling observation that isolation-reared monkeys do not “conform to the usual neurobiological rules any more than they conform to the usual social rules. . . . It is unlikely that tinkering with increasingly specific pharmacological fixes of what seems to be a general disorganization of brain function will be successful.” Because mammals need relatedness for their neurophysiology to coalesce correctly, most of what makes a socially functional human comes from connection—the shaping physiologic force of love. Children who get minimal care can grow up to menace a negligent society. Because the primate brain’s intricate, interlocking neural barriers to violence do not self-assemble, a limbically damaged human is deadly. If the neglect is sufficiently profound, the result is a functionally reptilian organism armed with the cunning of the neocortical brain. Such an animal experiences no compunctions about harming others of its kind. It possesses no internal motivation not to kill casually from minor frustration or for minimal gain. One young offender who crippled his victim during a mugging accounted for his actions in this way: “What do I care? I’m not her.”
America produces remorseless killers in bulk. One hundred years ago, Jack the Ripper riveted the attention of the Western world by doing away with five people. This culture would barely notice such modest exploits—so many have surpassed the quaintly amateurish Ripper that we cannot remember their names, much less their crimes. Squadrons of soulless assassins do not germinate by chance. These avenging Phoenixes arise from the neural wreckage of what once could have been a healthy human being.
As conditions worsen, the violence emerges younger and younger. Our culture now teems with lethal children. In Colorado, a pair of teenage boys armed with bombs and automatic weapons methodically execute a dozen classmates, a teacher, and then themselves. In Arkansas, a thirteen-year-old and an eleven-year-old boy coolly ambush and gun down a group of children and teachers— five dead, ten wounded. A California court convicts a twelve-year-old of beating a toddler to death. In Oakland, a six-year-old child breaks into an apartment and kicks in a baby’s skull. He is indicted for attempted murder—the youngest person ever to be charged with that crime in our country’s history. All too horribly real, these events evoke national hand-wringing, confusion, despair.
Stories like these contain tragedy to spare, but less mystery than many suppose. Limbic deficits engender uncontrolled viciousness, through a process established long ago within our fragile physiology. Recall that the brains of neglected children show neurons missing by the billions. Lest anyone think those vanished cells are inconsequential, our own children prove otherwise.
As Winston Churchill observed, there is no finer investment for any community than putting milk into babies. The potential for humanity lives inside every infant, but healthy development is an effort, not a given. If we do not shelter that spark, guide and nurture it, then we not only lose the life within but we unleash later destruction on ourselves.
PRIMARY SCARE PROVIDERS
The trends in many of America’s institutions are disquieting, if not alarming. Education is under siege, as classrooms in the world’s wealthiest nation regularly yield a bumper crop of scholastic ineptitude. Crowded courts have slowed almost to stasis, halting the revolution of their weary wheels every now and again to issue judgments increasingly distant from any commonsense conception of justice. Politicians are so mired in raising money for the chance to denounce one another on television that government has declined into a frantic auction of favors. And so it goes. Tendrils of causation from the limbic domain touch upon all of these tendencies.
One of the most ailing American institutions is, ironically, the ancient mission of healing the sick. The last century saw a two-part transformation in the practice of medicine. First, an illness beset the relationship between doctor and patient, then radical restructuring attacked the residual integrity of that attenuated tie.
The initial stage of medicine’s remodeling was the inadvertent distancing of doctors from human affairs. The first half of the twentieth century brought dazzling technologies—antibiotics, vaccines, X rays, anesthesia—that delivered sophisticated diagnostic acumen and unparalleled ability to cure. The age ushered in was also one of estrangement from patients. For the last thirty years, the paradox of Western medicine has been the seemingly inexplicable coexistence of technical excellence with unpopularity. Americans receive the world’s most advanced treatments, biomechanical miracles in power and scope. Yet patients complain fiercely. Doctors don’t listen, patients say; they are cold and busy technocrats. And the patients are right, because American medicine has come to rely on intellect as the agency of cure. The neocortical brain has enjoyed a meteoric ascendancy within medicine even as the limbic star has fallen into disfavor.
What doctors once knew, but cast aside for an extended gadgetry fling, is that patients come looking for both healer and expert. Illness arouses the ancient attachment machinery; it awakens a limbic need. When they go to the doctor, patients hope for the illuminating test, the correct diagnosis, the appropriate remedy. They also want someone who connects with them in spite of their suffering; they wish for a warm hand on their shoulder and the security of speaking with one who has been through this before. A dying patient described it this way:
I wouldn’t demand a lot of my doctor’s time. I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh to get at my illness. . . . I’d like my doctor to scan me, to grope for my spirit as well as my prostate. Without such recognition, I am nothing but my illness.
Western medicine dismissed these tools of healing as expendable hand-holding, a luxury that busy schedules could not permit. “Bedside manner” became a cursory interchange thought mildly reassuring but inessential, particularly when compared to the real science of pathophysiology.
Medicine lost sight of this truth: attachment is physiology. Good physicians have always known that the relationship heals. Indeed, good doctors existed before any modern therapeutic instruments did, in the centuries when the only prescriptions were philters deriving their potency from metaphoric allusion to the healer’s own person. The extraordinary results of the lab tests and procedures, the mastery they provided over the wily enemy of disease, proved seductive. Western medicine embraced the effective machines and ceded its historic soul.
The wholesale desertion of limbic attentiveness, once as much a part of medicine as the stethoscope, has been costly. A 1994 proposal in The Lancet, Europe’s most respected medical journal, advocated teaching acting techniques to medical students. The proposed utility of adding theatrical training to the curriculum? Providing physicians with the means to feign concern for patients, since their incapacity to care is too embarrassingly evident. “We would suggest that if physicians do feel antipathy toward patients, they should at least act as if they cared,” wrote the medical thespians. Here our finest doctors endeavor, without irony or shame, to pass off a good relationship as a kind of performance art. Their immodest proposal aptly captures the emptiness at the core of Western medicine. For many years, the medical community hasn’t believed that anything substantive travels between doctor and patient unless it goes down a tube or through a syringe. The rest can be comfortably omitted or conveniently faked.
Patients (mammals that they are) sensed the limbic void in American medicine and deserted en masse. Even while traditional medicine eschewed emotional aspects of healing, multiple groups sprang up to accommodate them: acupuncturists, chiropractors, masseuses, body workers, reflexologists, herbal therapists, and a host of others. The “alternative” healers proliferated in response to the demand for a context of relatedness. These limbically wiser settings are friendlier to emotional needs—they involve regular contact with someone who participates in close listening, and often, the ancient reassurance of laying on hands. Alternative medicine sees these activities as quintessential rather than incidental to healing. The result? Patients vote with their feet and their wallets. Alternative medicine now collects more out-of-pocket dollars than does its traditional, shortsighted predecessor.
So deep is the divide between neocortical and limbic medicine that it extends to the pills people are willing to take. The warm welcome given alternative practitioners has emboldened manufacturers to market alternative medications—so-called neutraceuticals, herbal or natural remedies for ailments ranging from AIDS to menopause. What is the appeal of natural pills? People feel able to trust them, even if the efficacy of the chemical constituents is more mythic than real. Current laws do not require proof of effectiveness for food additives, the legal class to which herbal remedies belong. Indeed, regulatory laxity allows such products to omit the ingredients they list on the label. (One study of ginseng preparations, for instance, found only half included ginseng at all; only a quarter provided any in a biologically usable form.) The bustling neutraceutical business—now with $5 billion per year in U.S. sales—is an economic testament to the depth of yearning for an earlier, more trustworthy, more humane brand of medicine.
Medicine’s movement away from limbic considerations abruptly accelerated in the 1990s, as solo practitioners and fee-for-service physicians congealed into the large corporate mass known as managed care. The emotional revamping was drastic: medicine was once mammalian and is now reptilian.
The administrative framework of medicine formerly permitted at least the possibility of human relationships between the participants, even if technology tended to get in the way. But the corporate takeover of the doctor-patient relationship fatally compromised medicine’s ailing emotional core. A corporation has customers, not patients; it has fiscal relationships, not limbic ones. Like crocodiles incapable of an aversion to cannibalism, HMOs prosper whether or not customers are consumed in the process. Individual doctors can care about patients, but all too often they do not have authority to implement the decisions that could protect those patients from harm. In today’s market, ER meets Jurassic Park. “Caveat emptor” has given way to “Horrescat emptor”—let the buyer be scared.
Corporate medicine cloaks its reptilian scales in warmer garments. Every fall, as open enrollment draws near, one cannot escape inundation in the voluptuous deluge of claimed corporate nurturance. Television and radio ads paint various insurers as hybrids of Marcus Welby, June Cleaver, and Mother Teresa. But the mother pitched never materializes. As patients have learned the hard way, HMOs and managed care outfits profit by spending less than subscribers pay in. They pursue this end with efficiency and ruthlessness. Doctors are bribed and bullied into not treating patients, while service rationers sequester themselves behind a thicket of bureaucracy so dense that it thwarts all but the most tenacious self-advocates. Many physicians are reluctant to air their discussions, but in private they are bursting with tales of corporate abuse. If you think that patients are not falling ill from preventable diseases, losing organs and limbs to deliberate delay, and dying from systematic inattention, then think again.
A Kentucky physician at a managed care organization confessed to causing a patient’s death by denying him the operation he needed to live. She had feared for her job if she approved the procedure; after she made the correct corporate decision, she was promoted for administrative thrift. “The distance made it easier,” she said, “like bomber pilots in war who never see the faces of their victims.” The New York State Health Commissioner discovered a short while ago that an HMO was using its data on cardiac surgery death rates to improve the selective routing of patients to New York hospitals. Did the insurer send its patients to the most dependable institutions? Of course not. Instead, administrators used the statistics to bargain for basement-rate prices from the most lethal centers. Then, coaxing along cherished dividends, they diverted patients to the cheapest facilities available, where those customers were likeliest to suffer and die.
Before it is safe to go back to the doctor, a mammal will have to be in charge. And before that can happen, our physicians will have to recapture their belief in the substantive nature of emotional life and the determination to fight for it.
Walker Percy wrote that “modern man is estranged from being, from his own being, from the being of other creatures in the world, from transcendent being. He has lost something—what, he does not know; he only knows that he is sick unto death with the loss of it.” The mysterious, absent element is a deep and abiding immersion in communal ties. In all of its varied and protean forms, love is the tether binding our whirling lives. Without that biological anchor, all of us are flung outward, singly, into the encroaching dark.
Humanity began in a precarious world where tiny bands foraged and scrimped for food by day, huddled together for warmth by night. With the advent of agriculture came mass aggregation in towns and cities. The industrial revolution took work out of the home, making the populace “a mass of undifferentiated equals, working in a factory or scattered between the factories, the mines, and the offices, bereft forever of the feeling that work was a family affair, done within the household.” Economies prospered as families dissipated. In pursuit of further riches, the information age demands a more thoroughgoing surrender—less time for relationships, less time for children, more time for impersonal everything. Before our lives wither away into dust, we might ponder how much more prosperity human beings can possibly survive.
A good deal of modern American culture is an extended experiment in the effects of depriving people of what they crave most. The consequences that flow from limbic ignorance are as grim as love’s victories are miraculous. The tragedy lies, as all tragedy does, in the knowledge that these sad outcomes once held the potential for greatness. What Charles Dickens wrote of the pair beneath the robe of Christmas Present is true of our society: “Where angels might have sat enthroned, devils lurked, and glared out menacing. No change, no degradation, no perversion of humanity, in any grade, through all the mysteries of wonderful creation, has monsters half so horrible and dread.” Our culture might trade back these devils for the divinity that our mammalian heritage accords us, if only we had the inclination to attend to limbic imperatives.
The capacious and monocular neocortical brain tells us that ideas perpetuate civilization. The thick marble walls of libraries and museums protect our supposed bequest to future ages. How short a vision. Our children are the builders of tomorrow’s world—quiet infants, clumsy toddlers, and running, squealing second graders, whose pliable neurons carry within them all humanity’s hope. Their flexible brains have yet to germinate the ideas, the songs, the societies of tomorrow. They can create the next world or they can annihilate it. In either case, they will do so in our names.