On Second Thought: the HEALTH & HAPPINESS issue by The Study ND

A PUBLICATION OF HUMANITIES NORTH DAKOTA

08.18

2ECOND THOUGHT

CONTENTS

02 Getting the Bad News By Everett C. Albers

04 Finding the Heart of Health and Happiness By Melanie Carvell 12

I Don’t Believe That Anymore By Kate Bowler

18 This Chair Rocks An Interview with Ashton Applewhite 26 Far from the Tree By Andrew Solomon

18 26 The constant happiness is curiosity. — ALICE MUNRO

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How to Prevent an Epidemic Like the Amercian Colonists Did By Andrew Wehrman

Finding Purpose for a Good Life. But Also a Healthy One. By Dhruv Khullar

46 Toothpicks in Jell-O By Caitlin Doughty 52 GameChangers Ideas Festival Schedule Grand Forks and Bismarck

THE PURSUIT OF HEALTH AND HAPPINESS

BRENNA DAUGHERTY GERHARDT

EXECUTIVE DIRECTOR

America’s Declaration of Independence proclaims the inalienable right to the pursuit of happiness. In the time since our founding,

Any views, findings, conclusions, or recommendations expressed in this magazine do not necessarily represent those of the National Endowment for the Humanities or Humanities North Dakota.

happiness has grown into a multi-billion-dollar industry. Yet current research shows that the pursuit of happiness tends to make individual America’s unhappy and that Americans are less happy today than they were fifteen years ago. So what is the secret to a healthy and happy life? The 2018 GameChanger ideas festival is dedicated to this question. We’ve gathered an innovative group of thinkers who have turned conventional thinking on its head. They will reveal the surprising healthcare debates happening during the American Revolution, delve into new research on the power of purpose and meaning to reshape health outcomes, challenge our assumptions about aging, question our fear of death and dying, and explore how people who love each other must struggle to accept each other—a theme in every family’s life.

Cover artwork: Ben Brick

Join us as we explore what really matters in the end.

ON SECOND THOUGHT is published by Humanities North Dakota. To subscribe, please visit: humanitiesnd.org

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GETTING THE BAD NEWS by Everett C. Albers

Friday, September 20, 2002

few weeks ago — but about twenty days past — I turned yellow, most jaundiced in eye and skin. Damning

whatever gods may be, convinced I had somehow contracted infectious hepatitis, I went to see a general practitioner. I did tests, ultra-soundings, CT scans, and ERCP (during which Bismarck physician Dr. Atam Mehtiratta most kindly put a stint in my bile ducts which has since returned me to a more natural color), and a week in the Mayo Clinics of Rochester where I had a test not done in North Dakota, an endoscopic ultrasound (EUS). I also had a little camera inserted into my stomach by a gifted surgeon who looked around. After all this I know what a young general physician trained at the University of North Dakota School of Medicine suspected from the moment he lay eyes on me — I have a malignant tumor on my pancreas that is too large to remove right now — or, as the curious language of pancreatic cancer goes, I’m not a candidate for a whipple at the moment. So, it’s on to a five- to six-week course of radiation/chemotherapy beginning next week with the hope that the tumor can be reduced enough so I can go back and get a whipple — but I have to wait for a month after the end of the treatment before a CT scan to have another look at the size of the tumor, etc. All of this is offered, my friends, as background to any mood changes and lack of productivity you may notice from me. After sitting around a week in Rochester, spending money at gloomy motels, I’m really ready to get some work done — and to bring my life in the humanities to this little problem before me. Therefore, for what it’s worth, I will be posting some of my meanderings while I continue to do my job as executive director of the North Dakota Humanities Council (now Humanities North Dakota)— and pay much more attention than I ever have to my wife, children, family and friends — so even this curse is a great blessing. Among the first thoughts I had after a long weekend last 14-15 September, waiting to hear on Monday afternoon

whether or not I was a candidate for the old whipple, were snatches of poetry I thought I had long forgot. When I was growing up in Oliver County, we memorized poetry — some of it pretty damned awful — through high school. Any of you remember William Cullen Bryant’s “Thantatopsis”? So live, that when thy summons comes to join The innumerable caravan, which moves To that mysterious realm, where each shall take His chamber in the silent halls of death, Thou go not, like the quarry-slave at night, Scourged to his dungeon, but, sustained and soothed By an unfaltering trust, approach thy grave Like one who wraps the drapery of his couch About him, and lies down to pleasant dreams. Tell you what, ‘tis easier saying than doing, I suspect. And I thought of Pliny the Younger and those letters from the first century about what makes life worth living. Finally, I thought about North Dakota’s gift to the millennia, Thomas Matthew McGrath, and that short poem— I must have travelled by the light Shining from the faces of all those I have loved. As I travel from this place on — and I have no intention of quietly shuffling off to Buffalo in the near future without a considerable fight — I hope for the courage of Dylan Thomas’ “Do Not Go Gentle Into That Good Night” — especially the fourth stanza: Wild men who caught and sang the sun in flight, And learn, too late, they grieved it on its way, Do not go gentle into that good night.

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Even this curse is a great blessing. Thank all of you out there for your kind encouragement — McGrath was right about one thing — “North Dakota is Everywhere” — and since we all know that all North Dakotans know each other, there are folks who seemed to have known what was happening to me almost before I did — especially after word was passed along at a certain cultural bastion in Dickinson, North Dakota, the Shamrock. I want to talk about the humanities with you from the perspective of someone who has been forced by circumstances to reconsider values and what is really important. Nothing is more important than the extraordinary people I have known. The last thing any of us need is any maudlin meanderings or premature eulogies (ad hominem attacks are welcome, however). The Lakota have a great word for the friends I know — I would talk with my kola. l

EVERETT CHARLES ALBERS was the founding director of Humanities North Dakota (formerly known as North Dakota Humanities Council). Ev brought his love of the humanities to the greatest challenge of his life, after he was diagnosed with pancreatic cancer in September 2002. Given three months to live, Everett lived and worked for another 18 months, while also writing daily, on-line journal entries in which he reflected on the people and experiences of his life, books and music, pie and the great humanities question of all time: “Where have we been, and where are we going?” And also, is there sour cream raisin pie in the next life? In honor of his legacy, Humanities North Dakota has re-digitized Ev’s online journal. Visit, gamechangernd.com, to find out more. 3

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FINDING THE HEART OF HEALTH AND HAPPINESS by Melanie Carvell

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“The groundwork of all happiness is good health.” —James Leigh Hunt

e know the basic ingredients of good health include eating well, staying active, and managing stress. But what motivates us to

develop these life-changing healthy habits and stick with them? What if the recipe resulted in more than just a clean bill of health from the doctor and the satisfaction of looking fit in Facebook posts? Scientific evidence shows us that good health and happiness are intimately related, and in fact, the single greatest benefit of a healthy lifestyle is happiness. Developing a blueprint for a healthier lifestyle can give us a return on our investment that includes more than just better checkups. Rather than being a selfish endeavor, working on our own health and happiness can be a strategic route to wellbeing, allowing us to become the best version of ourselves at home, at work, in our relationships, and in our communities. One of my cycling pals has a remarkable story of a successful lifestyle change. After a reasonably healthy life journey he found himself in a tough spot. His job had him traveling most days of the week, and weekends were a swirl of endless activity with his two school-age children. He didn’t feel like he had the time to invest in his own wellness even though he knew he should, and over time his weight crept up while his daily energy level dipped down. There were comments and 5

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concerns along the way; a coworker joked that if he kept gaining weight he’d soon be as fat as he himself was. His doctor voiced concern about the direction his health was heading. An older female neighbor (who apparently had lost an appropriate conversational filter) looked at him and said, “Oh my God, you’ve gotten fat!” But, the tipping point came when he asked his teenage daughter what she wanted for her graduation present. She said she simply wanted him to be healthy again. His daughter could have asked for anything, but she wanted her dad to be there for her in all of life’s important moments, not just for graduation. His love for his daughter and his goal of being a good example for his family led him to embark on a gradual lifestyle change. He started with exercising on an indoor cycle and then, with the encouragement of his neighbor who loaned him a touring bicycle, started riding outside. To stay accountable, the two of them set a goal to complete CANDISC, North Dakota’s five-day bicycle tour, that summer, and successfully crossed it off their list. A year later and carrying one hundred pounds less, he started running with another neighbor and continued to set goals while building a support network of great workout buddies. 6

Research proves that goals alone don’t motivate behavior until they have a personal meaning. Guilt, doctors’ orders, and even dire health consequences are not likely to inspire long-lasting changes. Choosing the right “why,” one that resonates with us personally, is the most important step on the path to better health—and ultimately, happiness. Become physically active for what you will gain rather than what you want to lose. Mountains of research demonstrate the many physical and mental benefits of moving more, but what is the best way to start and, more importantly, keep physical activity as an important part of our life? Dr. Michelle Segar, a behavioral sustainability and motivation scientist at the University of Michigan, has studied the most critical issue facing our society: the failure to achieve widespread adoption of health-promoting and disease management behaviors. Segar’s research shows that our “meaning” of exercise is a critical determinant of how successful we will be in maintaining a physically active lifestyle. Do you think of the ability to move as a gift you get to do every day, or as a necessary evil that feels like a chore? Thinking

of exercise as a chore you have to do or should do undermines motivation before you even start. Segar’s research also shows that if your number-one reason for starting an exercise program is to lose weight, you will likely be unsuccessful at continuing. Study participants who exercised as a way to lose weight actually accumulated the least amount of activity. Unfortunately, our most common reason for exercising is the least helpful for many of us who jump on the diet and fitness bandwagon, only to get frustrated and quit before we get a chance to benefit in any way. Weight loss and other health metrics such as healthy blood pressure, blood sugar, and cholesterol profiles are critically important, but the promise of good health “down the road” does not usually get us out of bed and moving today. Rather than focusing on the bathroom scale, focus on the daily positive rewards of being more active: connecting with others, decreasing your stress, gaining strength and energy, and improving mental focus. As humans, we are hardwired for instant gratification and are likely to sustain behaviors only if they have an immediate benefit to our daily life. The best determination of how likely we are to be successful keeping active is appreciating how moving more can add to our life today. As a result, you’ll be much more likely to stick to your exercise commitment, which gives you a fighting chance to benefit from improved health metrics and a happier, more fulfilling life. Rather than thinking of exercise as just a necessary tool for weight loss or other metrics, let’s look beyond that. Exercise for sanity, not vanity. Think of daily movement as your personal power source that fuels life and our many roles in it. Investing in our health makes us a much better investment for others. Early twentieth-century author Frank Gelett Burgess wrote, “Our bodies are apt to be our autobiographies.” What story will yours tell?

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Excercise for sanity, not vanity. live longer, healthier, and happier lives. His groundbreaking work on longevity focuses on the lifestyles of people living in the “blue zones,” those places in the world where people are living longer and happier lives with statistically less chronic disease. He has identified five areas: Okinawa, Japan; the Italian island of Sardinia; the Nicoya region of Costa Rica, the Greek island of Ikaria; and Loma Linda, California. By focusing on these bright spots of good health he has been able to tease out the common characteristics of longevity. In these places, people eat what is described as the Mediterranean diet: real food, consisting mostly of fruit, whole grains, greens, and beans each day. They consume avocados, nuts, and seeds, and cook with other healthy fats such as olive oil. They moderate their alcohol intake and eat meat and fish in small portions. They usually cook at home and have their largest meal midday, rather than in the evening, following the wise adage “Eat your own breakfast, share your lunch with a friend, and give most of your dinner to your enemies.” They follow the 80/20 rule, stopping when they feel their stomachs are 80 percent full. In these places the longest-lived folks don’t run marathons, join gyms, or take nutritional supplements. Instead, they live in supportive environments, often with community gardens and walking paths, that continually nudge them into moving more. They have a strong sense of purpose, close family ties, and are a part of social networks that support healthy behaviors. What can you take from these best practices to add years to your life, and most importantly, life to your years?

You are what you eat, so don’t be fast, easy, cheap, or fake. Dan Buettner is the founder of Blue Zones, an organization that helps Americans 7

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Our happiness benefits not only us, but everyone around us.

Connections with others are at the heart of our health and happiness. Along with eating more fruits and vegetables, “blue zone” folks are social folks. Connecting with other people is the number one predictor of physical, mental, and spiritual health. Strong personal relationships make it far more likely that life will be joyful, and longer. From Aristotle and Socrates to contemporary scientists, strong social bonds are recognized as the most meaningful contributor to happiness. We may take pride in being independent, but social connection is a fundamental human need. Being connected with others is just as important to health as regular exercise, stress management, and a healthy diet. If we have strong social connections we are twice as likely to have a healthy heart profile. Connectedness strengthens our immune system, decreases inflammation, helps us recover from disease faster, and lowers our levels of anxiety and depression. The number-one exercise adherence tool? Socialization. Being active with someone else is one of the best ways to ensure we get moving ourselves, and we are also much more likely to exercise more intensely. Most important weight loss tools? Peer support and accountability. Most critical component in overcoming addiction? Peer mentorship. Having a sponsor who has traveled the road of overcoming addiction is powerful, and those who mentor others are twice as likely to stay sober and drug-free themselves. Together we are always stronger! “We are happy when we are growing.” —William Butler Yeats Being happy, like being connected to others, significantly improves our health and longevity as well as boosting our immune system and resilience to stress. When we are happy we are much more likely to be effective leaders, and to be employees who are more cooperative, creative, and productive. Happiness researchers have found that positive emotions help us establish deeper social ties, which many argue is the most meaningful part of life. Our happiness benefits not only us, but everyone around us. Fifty percent of our happiness “set point” lies in our genes; life’s circumstances contribute ten percent, and forty percent is due to our intentional activity—how we think and act on a daily basis. What we do every day matters much more than what we do once in a while. Happiness is much more likely to come from experiences, not material things. Experiences contribute much more because we anticipate them, savor them, and they give us memories and stories to tell. They become a part of family lore. Happiness also comes from enjoying the process. The journey can be hard, whether training for a marathon, making a huge feast, writing a book, or raising a child. But more often than not, when we look at achievements, the defining moments were the experiences that led up to the achievement and the lessons learned along the way, the camaraderie discovered. Taking pleasure in the atmosphere of growth and realizing it is not necessarily the goal attained but the striving that brings us delight and contentment. The fun part doesn’t come later now is the fun part. “Everyone wants to live on top of the mountain,” Andy Rooney of 60 Minutes fame quipped, “but all the happiness and growth occurs while you’re climbing it.” We may think more accomplishments and accumulating possessions bring more joy, but we know true happiness comes from doing something of value and meaning for others. It is by spending oneself in the service of others that we become rich. Happiness comes from balancing care and compassion for others with care for oneself. An inspiring story of how helping others helps ourselves happened at the 2018 Boston Marathon this past April. At race time the temperature was 39 degrees Fahrenheit, the coldest in the marathon’s last three decades. Heavy rain was falling, and the wind was gusting up to 25 miles per hour. Desiree Linden, the scrappy five-foot-one, 96-pound determined Olympian faced the wretched conditions to become the first American woman to win the race in over thirty years. Desiree was struggling and seriously

contemplated quitting midway through the race. At that point she confided in Shalane Flanagan, one of her training partners and competitors, that she was not doing well and likely would not be able to finish. A few miles later, Shalane had to stop for a bathroom break and Desiree decided to slow down, wait for Shalene, and gradually work to bring her back up to the lead group. A couple of miles later, when the lead runner, Mamitu Daska from Ethiopia, made a surge in the race pace, Desiree dropped back again, this time to help another contender in the race who had fallen back, Molly Huddle. Things turned around for Desiree. At 22 miles she was in the lead, and continuing to push hard, she crossed the finish line first. She credits her surge and eventual win to taking the focus off her own pain and reaching out to help her competitors. Desiree said, “When you work together, you never know what’s going to happen. Helping her helped me, and I kind of got my legs back from there.” Along with compassion for others and for ourselves, cultivating a practice of gratitude can bring significant happiness to our lives. In our day-to-day lives it’s easy to get caught up in the things that go wrong and feel like we are under a cloud through which the sun will never shine. We tend to overlook everyday beauty and take the good people and positive things in our life for granted. Keeping a daily gratitude journal—writing down three good things that happened during each day along with how they affected you—can be a powerful way to learn how to notice and savor the good things in your life. Fostering a mindset of thankfulness is a proven way to bring joy to our lives. We cannot be grateful and unhappy at the same time. If we are not grateful we will be unlikely to ever be happy, no matter how much we have. “Nothing is worth more than this day.” —Goethe Along with gratitude and compassion, mindfulness tools like meditation and deep breathing are effective in creating better mental and physical wellbeing. Regular meditation is a proven way to improve sleep and boost our immune system, as well as being a powerful antidote to help decrease depression, anxiety, pain, migraines, and panic attacks. Being mindful simply means staying in the present moment, so we don’t get caught up in replaying yesterday or worrying about tomorrow. Hanging on to the past saps our energy, and worrying about tomorrow steals precious time from today. Being mindful helps us to enjoy life while it is happening, rather than missing out because of worry and busyness. Meditation can be as simple as setting down our juggling balls (and our phones!) for a moment and taking a few deep

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breaths. Concerned that you don’t have time to meditate? Keep in mind that connecting with your breath anytime throughout your day will bring benefits. Rather than reaching for your phone, the next time you are waiting in line at the grocery store or coffee shop, connect with your breath. Sitting at a red light or stuck in traffic? Keep your phone out of sight and use the moment to inhale slowly for a count of four, and exhale slowly for a count of six. Even short meditations give our brain a place of rest and a chance to “reset” to a more balanced, calm place. Novelist Anne Lamott said it best: “Almost everything will work again if you unplug it for a few minutes, including you.” By living life as best as you can this very moment, the past and the future will take care of themselves. Mindful people bring a measure of peace to their relationships and are less likely to be reactive or take things too personally. They are fully present when listening without trying to control, judge, or get in the last word. How do you leave others feeling after they have crossed your path? In this stressed-out, divisive world, we could all benefit from practicing mindfulness and meditation. “The secret to living well is to eat half, walk double, laugh triple, and love without measure.” —Tibetan Proverb My cycling pal put all the right ingredients together to be able to move toward health and happiness and navigate the rocky road to behavior change. It was his decision to embark on a new lifestyle that embraced health, and he did it for the right reasons that resonated deeply within him. He focused on the daily and immediate benefits of moving more to keep his motivation flowing instead of flagging. He progressed gradually, knowing that there would be ups and downs and times where he would have to forgive himself for setbacks and jump back on track. He found support systems and friends that could mentor him and keep him company on his new path. He now is in the business of mentoring others and gives back to the health of his community in many ways, which in turn helps keep him accountable. Let his journey inspire you to find yours. Our self-care is really our gift to the world. When we are well and happy it sets the stage for a life that is truly fulfilling for us, and for all those who surround us. l

MELANIE CARVELL is an inspirational health and wellness speaker who loves sharing her fitness enthusiasm with others. She is a physical therapist, worksite wellness consultant, six-time AllAmerican triathlete, and author of Running with the Antelope: Lessons of Life, Fitness and Grit on the Northern Plains. 9

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GAMECHANGER IDEAS FESTIVAL THINKER:

KATE BOWLER ideas festival

How does your view of your own success change in the face of a Stage IV cancer diagnosis? Are tragedies really tests of character, or simply misfortune? Kate Bowler, a divinity professor, young mother, and historian of the “American Prosperity Gospel” asks these questions and wonders how to continue to love life—and God—when confronted with an uncertain future. At thirty-five, Bowler had become a professor at the school of divinity at Duke and a new mother when she received the earth-shattering diagnosis of Stage IV colon cancer. As she struggled to find the balance between optimism and delusion, she wondered how to accept her own finitude without feeling like she was giving up.

As she learns to live with cancer as a chronic condition, Bowler speaks powerfully about the ways in which her brush with mortality transformed her. She also frankly addresses the uniquely American concept that tragedy is a test of character, and looks at the different ways that people try to rationalize suffering and catastrophe, for better or worse.

Bowler speaks powerfully about the ways in which her brush with mortality transformed her. AUTHOR OF

Everything Happens for a Reason: And Other Lies I’ve Loved.

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I DON’T BELIEVE THAT ANYMORE by Kate Bowler

here’s a branch of Christianity that promises a cure for tragedy. It is called by

many names, but most often it is nicknamed the “prosperity gospel” for its bold central claim that God will give you your heart’s desires: money in the bank, a healthy body, a thriving family, and boundless happiness. I grew up on the prairies of Manitoba, Canada, surrounded by communities of Mennonites. I learned at my Anabaptist Bible camp about a poor carpenter from Galilee who taught that a good life was a simple one. Though most Mennonites abandoned bonnets and buggies long ago, they kept their concerns about the greediness of modern life. Everyone had a grandpa who once ruined a gleaming new car by painting the bumpers black to hide the chrome and knew that the most holy words outside of the Scriptures were “I got it on sale.” But when I was eighteen or so, I started hearing stories about a different kind of faith with a formula for success, and by twenty-five I was traveling the country

interviewing the prosperity gospel’s celebrities. Eventually, I wrote the first history of the movement from beginning to end. I spent years talking to televangelists who claimed spiritual guarantees for how to receive divine money. I held hands with people in wheelchairs praying at the altar to be cured. I thought I was trying to understand how millions of North Americans had started asking God for more. How they seemed to want permission to experience luxuries of life as a reward for good behavior. After all, the movement was best known in popular culture for Jim and Tammy Faye Bakker, the de facto King and Queen of 1980s televangelism. Their media empire toppled when Jim was convicted of financial fraud, and the scandal cemented in most people’s minds that the idea that the prosperity gospel was fundamentally about gold faucets, thick mink coats, and matching his-and-her Mercedes-Benzes. And I did discover that the prosperity gospel encourages people (especially its leaders) to buy private jets and multimillion-

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I plead with a God of Maybe, who may or may not let me collect more years. dollar homes as evidence of God’s love. But I also saw the desire to escape. Believers wanted an escape from poverty, failing health, and the feeling that their lives were leaky buckets. Some people wanted Bentleys but more wanted relief from the wounds of their past and the pain of their present. People wanted salvation from bleak medical diagnoses; they wanted to see God rescue their broken teenagers or their misfiring marriages. They wanted talismans to ward off the things that go bump in the night. They wanted a modicum of power over the things that ripped their lives apart at the seams. The prosperity gospel is a theodicy, an explanation for the problem of evil. It is an answer to the questions that take our lives apart: Why do some people get healed and some people don’t? Why do some people leap and land on their feet while others tumble all the way down? Why do some babies die in their cribs and some bitter souls live to see their great-grandchildren? The prosperity gospel looks at the world as it is and promises a solution. It guarantees that faith will always make a way. I would love to report that what I found in the prosperity gospel was something so foreign and terrible to me that I was warned away. But what I discovered was both familiar and painfully sweet: the promise that I could curate my life, minimize my losses, and stand on my successes. And no matter how many times I rolled my eyes at the creed’s outrageous certainties, I craved them just the same. I had my own prosperity gospel, a flowering weed grown in with all the rest. Married in my twenties, a baby in my thirties, I won a job at my alma mater straight out of graduate school. I felt breathless with the possibilities. Actually, it’s getting harder to remember what it felt like, but I don’t think it was anything as simple as pride. It was certainty, plain and simple, that God had a worthy plan for my life in which every setback would also be a step forward. I wanted God to make me good and make me faithful, with just a few shining accolades along the way. Anything would do if hardships were only detours on my long life’s journey. I believed God would make a way. 14

I don’t believe that anymore. One moment I was a regular person with regular problems. And the next, I was someone with cancer. Before my mind could apprehend it, it was there— swelling to take up every space my imagination could touch. A new and unwanted reality. There was a before, and now there was an after. Time slowed to a pulse. Am I breathing? I wondered. Do I want to? Every day, I prayed the same prayer: God, save me. Save me. Save me. Oh, God, remember my baby boy. Remember my son and my husband before you return me to ashes. Before they walk this earth alone. I plead with a God of Maybe, who may or may not let me collect more years. It is a God I love, and a God that breaks my heart. Anyone who has lived in the aftermath of something like this knows that it signifies the arrival of three questions so simple that they seem, in turn, too shallow and too deep. Why? God, are you here? What does this suffering mean? At first those questions had enormous weight and urgency. I could hear Him. I could almost make out an answer. But then it was drowned out by what I’ve now heard a thousand times. “Everything happens for a reason” or “God is writing a better story.” Apparently God is also busy going around closing doors and opening windows. He can’t get enough of that.

The world of certainty had ended and so many people seemed to know why. Most of their explanations were reassurances that even this is a secret plan to improve me. “God has a better plan!” “This is a test and it will make you stronger!” Sometimes these explanations were peppered with scriptures like “We know that for those who love God all things work together for good” (Romans 8:28). Except the author,

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Paul, worshipped God with every breath until his body was dumped in an unmarked grave. But I knew what they were saying. It would be nice if catastrophes were divine conspiracies to undo what time and unfaithfulness had done to my wandering soul. Other people wanted to assure me that what I’d had was enough. “At least you have your son. At least you’ve had an amazing marriage.” I had been stripped down to the studs, and everything of worth that I had accumulated was being appraised with a keen eye. I became certain that when I died some beautiful moron would tell my husband that “God needed an angel,” because God is sadistic like that. This is what I thought sometimes. What people would say to the man with sandy hair and eyes I have loved since we were fifteen and thought we would never die. I don’t think I knew enough about longing ten years ago, when I started investigating the prosperity gospel. I had just bought a little house with the man I love—filled it with books, IKEA furniture, and a soft dog with legs as stout as soup cans. I was steeped in the lore of eternal youth. My life was something I could mold, or at least correct with a surge of determination. It was the same unlimited confidence that the prosperity gospel calls “victory.” (And I might have chalked up my successes to my own hard work and a little luck.) Nothing was broken yet that could not be fixed. But what gives the prosperity movement breadth and depth for many is its thorough accounting for the pain of life, and for the longing we have for restoration. Those Americans trapped in failing bodies or broken relationships or the painful possibility that their lives might never be made whole can turn to this message of hope. If it is a game—with rules for success that anyone can use—then maybe they can win. I wish this were a different kind of story. But this is a book about befores and afters and how people in the midst of pain make up their minds about the eternal questions: Why? Why is this happening to me? What could I have done differently? Does everything actually happen for a reason? If I accept that what is happening is something I cannot change, can I learn how to let go? l

MEET KATE ON SEPTEMBER 6, AT THE GAMECHANGER IDEAS FESTIVAL IN GRAND FORKS. 15

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Ashton debunks our culture’s most pervasive myths about getting older.

GAMECHANGER IDEAS FESTIVAL THINKER:

ASHTON APPLEWHITE

ideas festival

Why is society’s view of aging so grim when the lived reality is so different? In her book This Chair Rocks: A Manifesto Against Ageism, Ashton Applewhite declares that it’s time to dismantle the last acceptable prejudice; it’s time for age pride. In her candid talks she debunks our culture’s most pervasive myths about getting older. And with her funny, straight-talking approach, audiences realize the often-overlooked benefits of advanced age, championing the need for greater age-based diversity in the workplace and our institutions. Applewhite has been recognized by the American Society on Aging as an expert on ageism.

WONDERING IF SOMETHING YOU SAW, HEARD, OR DID IS AGEIST?

Ashton Applewhite’s blog, Yo, Is This Ageist? is here to answer your questions.

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THIS CHAIR ROCKS An Interview with Ashton Applewhite

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Aging means living, which is why it’s so damn interesting.

YOU WANT TO REFRAME THE WAY AMERICAN CULTURE SEES AGE AND AGING. WHAT GOT YOU STARTED ON THIS PATH? About eight years ago I began interviewing people over 80 for a project called “So when are you going to retire?” and reading about longevity. It didn’t take long to realize that almost everything I thought I knew about aging was wrong. I had no idea that people are happiest at the beginnings and the ends of their lives, for example. That the vast majority of Americans over 65 live independently. The older people get, the less afraid they are of dying. Why don’t more people know this stuff? Because we live in a culture that drowns out all but the negative about growing old, or even just aging past youth. Why is that? Because social and economic forces frame aging as a problem, so they can sell us remedies to “fix” or “stop” or “cure” it. Aging is a natural, lifelong, profoundly enriching process—experience tells us so. Aging means living, which is why it’s so damn interesting. And to paraphrase British journalist Anne Karpf, it makes no more sense to be anti-aging than anti-breathing. IF YOU COULD BANISH ONE STEREOTYPE ABOUT AGING, WHAT WOULD IT BE? The notion that older people are alike! It’s why people think everyone in a retirement home is the same age— “old”—even though residents can span four decades. (Can you imagine thinking that way about a group of 20- to 60-year-olds?) It’s why the last box on those marketing checklists—you know, 18-26, 27-39, etc., end at 65+—as though everyone over 65 buys the same stuff and does the same things. Stereotyping—the assumption that all members of a group are the same—underlies all the “isms.” It’s always a mistake, but especially when it comes to age, because as the years pass, of course we grow more different from one another. It’s why geriatricians say: “If you’ve seen one 80-year-old, you’ve seen one 80-year-old.” We all age at different rates— mentally, physically, and socially—which is why there’s no such thing as “acting your age.” Chronological age tells you

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A growing body of evidence shows that attitudes towards aging have an actual, measurable, physical effect on how we age.

almost nothing about an individual—not what they’re listening to or who they’re voting for or where they’re headed—and the older the person, the less reliable an indicator it becomes. YOU MAKE A CASE FOR AN ANTI-AGEISM CAMPAIGN AS A PUBLIC HEALTH INITIATIVE. TELL US ABOUT THAT. A growing body of evidence shows that attitudes towards aging have an actual, measurable, physical effect on how we age. There’s no inherent reason for the effect to be negative. But an ageist culture tells us that wrinkles are ugly. Old people are incompetent. It’s sad to be old. When we assimilate these stereotypes, they become part of our identity, and this influences how our brains and bodies function. In one experiment, social scientists primed a group of college students with negative age stereotypes—words like “forgetful,” “Florida,” and “bingo”—that they flashed on a screen too briefly for the subjects to become aware of them. The students then walked to the elevator measurably more slowly than a control group! Imagine the effect on older people for whom the terms are more relevant, and thus more likely to become self-fulfilling prophecies. People with more positive feelings about aging behave differently from those convinced that growing old means becoming irrelevant or pathetic. They do better on memory tests and have better handwriting. They can walk faster and are more likely to recover fully from severe disability. And they actually live longer—an average of seven and a half years. Everyone agrees that health has the biggest effect on how we age—and how much it costs. So think what a national anti-ageism campaign would do to extend not just the lifespan but the “healthspan” of all Americans. WHY DO SO MANY OF US HAVE SUCH A HARD TIME ACTUALLY ADMITTING OUR AGE…SAYING IT OUT LOUD? You’d have to live in a cave to miss the messages all around us that old=bad, and that aging is to be feared and avoided by any means necessary. No wonder so many of us are reluctant to part with the equivalent of a cultural “sell-by” date! It’s an understandable strategy. Attempting to “pass” for younger, the way people of color have passed for white and gay people for straight, is a way to avoid being discriminated against. But “passing” takes a psychological toll, because it’s rooted in denial and distaste, even disgust. We’re reluctant to divulge our age because we’ve internalized the profoundly ageist notion that our older self is inferior to our younger one. Do you honestly think that the person you are now has less to offer than the 20or 30-something you once did? That you’re less interesting now? Less valuable? How about less attractive? If that gets a nod, consider the industries that make billions by commodifying our dissatisfaction with our bodies—especially women’s. Who gets to decide that wrinkles are ugly? It’s time to look more generously at ourselves, the way the body-acceptance movement urges, and to stop colluding in devaluing ourselves as older women. When we claim our age, the number loses its power over us. It’s a little like a spell breaking. We can’t stop aging, even if we wanted to, but we can change the way we feel about it—the first step in any revolution. Then we can start to see where those ageist messages come from, and work together to challenge the structures that benefit from them. WHY DO YOU DISLIKE THE TERM “SUCCESSFUL AGING”? Terms like “successful aging” and “productive aging” and “active aging” are popular, and provide an upbeat counterpoint to the standard narrative of aging-as-decline. They’re

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seductive, because we really, really want to think we can keep doing the things we love for as long as we live. We often can—versions of them, that is—especially if we have access to health care, and exercise, and eat well. But the goalposts shift. In addition to taking care of ourselves, we’d do well to decouple self-worth from longstanding measures of earning power or physical prowess. Much is not under our control, and making the necessary supports available to all older Americans will require implementation at the policy level. It’s important to keep in mind that many of the resources that help us “age well” are predominantly available to the lucky and reasonably well off. Sanitized or romanticized exemplars of “successful aging”—those silver-maned couples waltzing on the foredeck of a cruise ship—set an unreasonable standard and suggest that less “successful” agers are responsible for their circumstances. Everyone can make sensible choices, but barriers like heavy caregiving responsibilities, inadequate health care, and neighborhoods with few resources make it more difficult. Blaming the poor for “bad choices” makes aging another arena in which we succeed or fail based on terms that are far from neutral. There’s a lot of harsh judgment of olders who aren’t physically mobile or conventionally economically productive, and that’s not OK. All aging is successful—not just the sporty version— otherwise you’re dead. ARE OLDERS REALLY AS MUCH OF AN ECONOMIC DRAG ON SOCIETY AS THE MEDIA PORTRAYS? Absolutely not! People 50 and up fuel the significant, fast-growing, and often-overlooked “longevity economy,” which according to AARP accounted for 46 percent of US gross domestic product ($7.1 trillion) in 2012. By 2021 the 50-plus age group is projected to drive

more than half of US economic activity, as their spending fuels industries that include apparel, health care, education and entertainment. These statistics capture only part of the economic contribution of older Americans, whose unpaid volunteer work in 2013 was valued at $67 billion. And while “entrepreneur” might conjure up an image of a kid in that proverbial garage, twice as many successful American entrepreneurs are over age 50 as in their early 20s. More resources have always flowed from older generations to younger ones than the reverse. This is despite widespread age discrimination in employment, which prevents older workers from finding challenging work of which they’re eminently capable, and relegates them to jobs that don’t take advantage of their skills and experience—Wal-Mart greeters, say. It also makes it harder for them to find part-time and volunteer positions. Discouraged and diminished, many become economically dependent, contributing to the misperception that olders are a net burden to society, but it’s not by choice. SOCIETY HAS GROWN FAR LESS TOLERANT OF SEXISM AND RACISM. WHY DO AGEIST ATTITUDES AND BEHAVIORS STILL GET A PASS? That’s what I’d like to know! Can you imagine anyone complacently identifying himself as sexist or racist? Yet no one even blinks when older people are described as incompetent, or boring, or even repulsive. (And most people are unaware that younger people also face age bias.) Older people can be the most prejudiced of all, having had a lifetime to internalize negative myths and stereotypes that have gone unquestioned—until now. Diversity became a buzzword because society grew less tolerant of racism and sexism and homophobia. We want different

faces around the table because we don’t think access to opportunity should depend on what someone looks like. Graying hair and wrinkles count. It is high time to make the last socially sanctioned prejudice as unacceptable as any other kind. If that seems like a tall order, look at how much has shifted in how we look at gender, and how rapidly. It used to be viewed as a rigid binary, male or female, but we now understand that it’s far more fluid. If gender can be conceived of this way, why on earth not age, which is inherently, obviously, a continuum? Why not shake off our fear of being on the “wrong” side of some imaginary old/young divide and embrace a more flexible, friendly, and far more rational view of age? YOU CALL YOURSELF AN OLD PERSON IN TRAINING. WHY? I’m 63. I know I’m not young, I don’t see myself as old, and I know a lot of people feel the same way. We spend a lot of energy pretending that the old are somehow not us—not even future us— and that we’ll somehow never get old. Even though it’s irrational. Even though we’re doomed to fail. Even though it fills us with needless dread. Even though that denial is where ageism takes root. That’s why I’ve become an Old Person in Training, a phrase I appropriated from geriatrician Joanne Lynn. Becoming an Old Person in Training bridges that divide between our younger and older selves, and connects them empathically. It acknowledges the inevitability of growing old while relegating it to the future, albeit at an ever-smaller remove. It swaps purpose and intent for dread and denial. It’s a relief. It feels right and it makes sense. What’s does becoming an Old Person in Training involve? It means looking at older people instead of past them, remembering they were once our age, seeing resilience alongside infirmity, 21

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Age pride is for dissed teenagers and dismissed olders and everyone in between. allowing for sensuality, enlarging our notion of beauty, and acknowledging that an apartment, or a room or even just a bed can be home to an internal world as rich as ours—and very possibly richer. It means thoughtful peeks through the periscope of an open mind at the terrain we’ll inhabit when we are finally old. I see the 90-year-old me as withered and teetery, but also curious and content. Envisioning her won’t make it happen, but the aspiration will surely help. The consensus from people over 80, who should know, is that young people worry way too much about getting old. So the earlier we make this imaginative leap, the better—and the better equipped we’ll be to benefit from the journey. YOU’D LIKE YOUR BOOK, This Chair Rocks: A Manifesto Against Ageism, TO HELP CATALYZE A MASS MOVEMENT AGAINST AGEISM, THE WAY RACHEL CARSON’S Silent Spring CATALYZED THE ENVIRONMENTAL MOVEMENT. WHAT KIND OF ACTIONS WOULD YOU LIKE TO SEE? My book lays out a blueprint in every domain. Change starts between our ears, with the difficult task of unlearning beliefs we’ve held all our lives. Some places to start: Look for ways in which you’re ageist instead of looking for evidence that you aren’t. You can’t challenge bias unless you’re aware of it, and everyone’s biased some of the time. Talk to people significantly older and younger than you, and listen carefully. If you don’t know many of them, seek them out. The next time you wonder whether an outing or an outfit or an attitude is age-appropriate, reconsider the question. There’s no such thing. Change ripples outward when we point out ageist behaviors and beliefs in the world around us. Some places to start: Train yourself to notice when everyone in a group is the same age, and unless there’s some legitimate reason, speak up about it. Assume capacity, not incapacity. Don’t assume someone is too old—or too young—to weigh in on a topic or take on a responsibility. 22

If you’re on the receiving end of an ageist comment, ask gently, “Why would you say [or think] that?” Then just be quiet. If you’re feeling ambitious, start a consciousness-raising group around age bias. This powerful tool catalyzed the women’s movement in the 1960s and ’70s. Changing the culture is a tall order, but look at how women’s roles have changed in a single generation, and at the amazing progress we’ve made in this century alone against homophobia and transphobia. IF THIS NEW RADICAL AGE MOVEMENT HAD A SLOGAN, WHAT WOULD YOU LIKE IT TO BE? Age pride! Age pride is for dissed teenagers and dismissed olders and everyone in between. Age pride is for Maggie Kuhn, founder of the Gray Panthers, who said, “We must be proud of our age” and who, if she’d lived long enough, would have beaten me to “Occupy age!”—my other favorite slogan. If marriage equality is here to stay, why not age equality? If gay pride has gone mainstream, and millions of Americans now take pride in identifying as disabled, why not age pride? The only reason that idea sounds outlandish is because this is the first time you’ve encountered it. It won’t be the last. Longevity is here to stay. Everyone is aging. Dismantling ageism benefits us all. l

MEET ASHTON ON OCTOBER 13, AT THE GAMECHANGER IDEAS FESTIVAL IN BISMARCK.

PL A N NOW TO ATTEND THE 16TH A NNUAL

South Dakota Festival of Books Thursday, September 20–Sunday, September 23 Brookings & Sioux Falls 2018 Programming Initiative, “Democracy and the Informed Citizen” To complement year-round, statewide programs focusing on public trust and the media, the Festival of Books will feature Pulitzer Prize-winning authors and journalists providing context on changes in news gathering and delivery and discussing “infoliteracy”—thinking critically amidst the proliferation of available media. Featuring More Than 50 Presenters Writing Workshops Panel Discussions Book Signings Poetry Readings Children’s Activities

2018 One Book South Dakota: Informing the News: The Need for Knowledge-Based Journalism by Thomas E. Patterson, a political science graduate of SDSU and Bradlee Professor of Government and the Press at the Harvard Kennedy School. Patterson will present a keynote at the Festival and visit SDSU journalism classes.

PULITZER PRIZE–WINNING PRESENTERS THIS YEAR ARE: Annette Gordon-Reed, author of The Hemingses of Monticello

Caroline Fraser, author of Prairie Fires Timothy Egan, won for “How Race Is Lived in America,” New York Times

Jacqui Banaszynski, won for “AIDS in the Heartland,” St. Paul Pioneer Press

Special Guest, Alice Sebold, author of The Lovely Bones, one of America’s 100 Favorite Novels according to PBS’s The Great American Read series will also be making a presentation!

Bringing Readers & Writers Together sdhumanities.org

OTHER NOTABLE AUTHORS PRESENTING THIS YEAR INCLUDE: William Kent Krueger, author of Desolation Mountain; Leif Enger, author of Virgil Wander; Joseph Marshall III, a past One Book South Dakota author; Amby Burfoot, winner of the 1968 Boston Marathon and author of Run Forever; Children’s writers including Kara LaReau, author of The Infamous Ratsos; Local Writers; Tribal Authors; and Media Professionals including Andy Boyle, director of Platform Architecture for Axios and Linsey Davis, Emmy-winning reporter for ABC News; and many more!

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GAMECHANGER IDEAS FESTIVAL THINKER:

ANDREW SOLOMON ideas festival

Andrew Solomon, author of Far from the Tree: Parents, Children, and the Search for Identity, is a writer and lecturer on politics, culture and

psychology, a Professor of Clinical Psychology at Columbia University Medical Center, and President of PEN American Center.

Solomon’s startling proposition in Far from the Tree is that being exceptional is at the core of the human condition—that difference is what unites us. He writes about families coping with deafness, dwarfism, Down syndrome, autism, schizophrenia, or multiple severe disabilities; with children who are prodigies, who are conceived in rape, who become criminals, who are transgender. While each of these characteristics is potentially isolating, the experience of difference within families is universal, and Solomon documents triumphs of love over prejudice in every chapter. All parenting turns on a crucial question: to what extent should parents accept their children for who they are, and to what extent they should help them become their best selves. Drawing on ten years of research and interviews with more than three hundred families, Solomon mines the eloquence of ordinary people facing extreme challenges. Elegantly reported by a spectacularly original and compassionate thinker, Far from the Tree explores how people who love each other must struggle to accept each other—a theme in every family’s life.

To what extent should parents accept their children for who they are, and to what extent should they help them become their best selves? FAR FROM THE TREE DOCUMENTARY FILM OPENS IN THEATERS NATIONWIDE ON JULY 20. Find out more at andrewsolomon.com

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FAR FROM THE TREE by Andrew Solomon

ANDREW SOLOMON tells the stories of parents who not only learn to deal with their exceptional children but also find profound meaning in doing so.

A PINK BALLOON When I was seven, my mother, my brother and I went to Indian Walk Shoes, and as we were leaving, the salesman asked what color balloons we’d like. My brother wanted a red balloon. I wanted a pink one. My mother countered that I didn’t want a pink balloon, and reminded me that my favorite color was blue. I said I really wanted the pink, but under her glare, I took the blue one. The fact that my favorite color now is blue but I am still gay is evidence of both my mother’s influence and its limits. She once said, “When you were little, you didn’t like to do what other kids liked to do, and I encouraged you to be yourself.” She added, only half-ironically, “I sometimes think I let things go too far.” I have sometimes thought she didn’t let them go far enough. But her encouragement of my individuality, although doubtless ambivalent, has shaped my life. When I was little, my mother used to say, “The love you have for your children is like no other feeling in the world, and until you have children, you don’t know what it’s like.” I took those words as the greatest compliment in the world. But when I was an adolescent, I thought that, as a gay person, I probably couldn’t have a family, and so her words made me anxious. After I came out of the closet, those words made me furious. I said, “I’m gay. I’m not going to have children. And I want you to stop saying that.” TWO KINDS OF IDENTITY In 1993, I was asked by my editors at the New York Times Magazine to write a piece about Deaf culture. I

had thought of deafness entirely as an illness, but now I went out into the deaf world. I went to deaf clubs; I saw performances of Deaf theater and poetry. I even went to the Miss Deaf America Contest in Nashville, Tennessee, where people complained about that slurry Southern signing. As I plunged deeper and deeper into the Deaf world, I became convinced that Deafness was a culture organized around the shared use of sign language. It wasn’t my culture, and I didn’t particularly want to join it. But I appreciated that for those who are members of it, it feels as valuable as Latino culture or gay culture or Jewish culture do to their constituents. Most deaf children are born to hearing parents, who often try to cure them; deaf people often discover community only in adolescence. The pattern seems to echo the experience of gay people, who are mostly born to straight parents and often find gay identity only in adolescence or thereafter. Then a friend of a friend of mine had a daughter who was a dwarf. She suddenly found herself confronting questions that now began to seem familiar. Should she tell her daughter that she was just like everyone else, but shorter? Or should she try to construct some kind of dwarf identity and get involved in the Little People of America? Here it was again. A family that perceived itself to be normal, with a child who seemed to be extraordinary. So I hatched the idea that there are really two kinds of identity. There are vertical identities which are passed down generationally from parent to child. Those are characteristics such as

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ethnicity, nationality, language, often religion. While some of them can be difficult, there is no attempt to cure them. It can be argued that it is harder in the United States to be a person of color. And yet, we have nobody who is trying to ensure that the next generation of children born to AfricanAmericans and Asians come out with creamy skin and yellow hair. Then there are horizontal identities, those that occur when someone has an inherent or acquired trait that is foreign to his or her parents, and must therefore acquire identity from a peer group. Such horizontal identities may reflect recessive genes, random mutations, prenatal influences, or values and preferences that a child does not share with his progenitors. Being gay is a horizontal identity; most gay kids are born to straight parents, and while their sexuality is not determined by their peers, they learn gay identity by observing and participating in a subculture outside the family. Physical disability tends to be horizontal, as does genius. Psychopathy, too, is often horizontal; most criminals are not raised by the Mafia, and must invent their own treachery. So are conditions such as autism and intellectual disability. A child conceived in rape is born into emotional challenges that his own mother cannot know, even though they spring from her trauma. Parents have almost always tried to cure those horizontal identities. People who have these conditions are frequently very angry because they feel as though their parents don’t love them, when what actually has happened is

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that their parents don’t accept them. Love is ideally present unconditionally throughout the relationship between a parent and a child. But acceptance is something that takes time. It always takes time. And in order for a condition to emerge as an identity, three levels of acceptance need to be in place: selfacceptance, family acceptance, and social acceptance. Each of these enables and depends on the others.

READJUSTING PARENTAL EXPECTATIONS When Clinton Brown was born, he was diagnosed with diastrophic dwarfism, a very disabling condition. His parents were told that he would never walk or talk or think. The doctors suggested that they leave him at the hospital so that he could die there quietly. But his mother, Cheryl, said she was going to take her son home. And even though she didn’t have tremendous educational or financial advantages, she found the best doctor in the country for dealing with diastrophic dwarfism. In the course of Clinton’s childhood, he had thirty major surgical procedures, as a result of which he now can walk. While he was in the hospital, he had tutors to help him with his schoolwork, and because there was nothing else to do, he worked very hard. He ended up achieving at a level that had never before been contemplated by any member of his family. He went to college, where he lived on campus and drove a specially fitted car that accommodated his unusual body. “I was terrified about his drinking and driving,” Cheryl said. “I went past a bar and I saw his car parked there—it’s very easy to recognize with all those fittings. I didn’t think I could march in there like I wanted, but I left him three messages and sat home by the phone waiting for him to call. Then I thought, okay, if you’d told me when he was born, that my worry would be that he’d go out driving after drinking with his college buddies, I’d have been overjoyed.” I asked her, “What do you think you did that helped him to emerge as this charming, accomplished, wonderful person?” And she said: “What did I do? I loved him, that’s all. Clinton just always had that light in him. And we were lucky enough to be the first to see it there.” A SHIFT IN A NATION’S ATTITUDE A lot of ink has been given to our progress on gay rights; the fact that national attitudes have shifted is in the headlines every day. But we forget how we used to see people who had other differences, how inhuman we could imagine a human being to be. In a 1968 article in the Atlantic Monthly, a voice of 28

liberal America, ethicist Joseph Fletcher argued: People [with children with Down’s syndrome] … have no reason to feel guilty about putting a Down’s syndrome baby away, whether it’s “put away” in the sense of hidden in a sanitarium or in a more responsible lethal sense. It is sad, yes. Dreadful. But it carries no guilt. True guilt arises only from an offense against a person, and a Down’s is not a person. One of the families I interviewed, Tom and Karen Robards, were taken aback when, as young and successful New Yorkers, their first child, David, was diagnosed with Down syndrome. The educational opportunities for him were not what they should be, and so with a few other parents, they created a small facility with two classrooms to educate kids with DS. Over the years, that initiative grew into the Cooke Center, where thousands upon thousands of children with intellectual disabilities have now been taught. In the time since that Atlantic story ran, the life expectancy for people with Down syndrome has tripled. People with Down syndrome are actors or writers; some are able to live fully independently in adulthood. The Robardses had a lot to do with that shift. I asked, “Do you regret it? Do you wish your child didn’t have Down syndrome? Do you wish you’d never heard of it?” And Tom said, “If I could have David who he is but not have Down syndrome? I would do it in a minute. I would do it because I think for David, it’s hard being in the world with Down syndrome, and I’d like to give him a happier, easier life. But the diversity of human beings makes the world a better place, and if everyone with Down syndrome were cured, it would be a real loss. The personal wish and the social wish are in opposition. The question is whether we collectively learn more than we hurt.” Karen shook her head. “I’m with Tom. If I could cure David, I would, for David. But I think that we’ve grown so much as a result of having to deal with this. We’ve had so much purpose. I’d never have believed 23 years ago when he was born that I could come to such a point, but I have. For David, I’d cure it in an instant; but for us, I wouldn’t exchange these experiences for anything. They’ve made us who we are, and who we are is so much better than who we would have been otherwise.”

CHILDREN WANT TO BE WHO THEY ARE We live at a point when social acceptance for these and many other conditions is on the up and up. And yet we also

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If you’d told me when he was born, that my worry would be that he’d go out driving after drinking with his college buddies, I’d have been overjoyed.

live at the moment when our ability to eliminate those conditions has reached unimagined heights. Most deaf infants born in the United States will receive cochlear implants, which are surgically placed in the brain and connected to a receiver, allowing them to acquire a facsimile of hearing. A compound that has been tested in mice, BMN-111, blocks the action of the achondroplasia gene. Achondroplasia is the most common form of dwarfism, and mice with the achondroplasia gene who have been given BMN-111 grow to full size. Testing in humans has already begun. Blood tests now in development would pick up Down syndrome earlier in pregnancies than ever before, making it easier to terminate those pregnancies. I believe in both social and medical progress. But I think it’s a tragedy when one of them doesn’t see the other. When social and medical progress clash as they have in these conditions, I sometimes think it’s like those moments in grand opera when the hero realizes he loves the heroine at the exact moment that she lies expiring on the divan. The most frequent question of parenthood is what to validate in our children, and what to ameliorate. Jim Sinclair, a prominent autism rights activist and himself autistic, said: When parents say, “I wish my child did not have autism,” what they’re really saying is, “I wish the autistic child I have did not exist, and I had a different (non-autistic) child instead.” Read that again. This is what we hear when you mourn over our existence. This is what we hear when you pray for a cure. This is what we know, when you tell us of your fondest hopes and dreams for us: that your greatest wish is that one day we will cease to be, and strangers you can love will move in behind our faces. It’s a very extreme point of view, but it points to the reality that people engage with the life they have. And they don’t want to be cured or changed or 29

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eliminated. They want to be whoever it is that they are. One of the families I interviewed for this project was the family of Dylan Klebold, one of the perpetrators of the Columbine massacre. The first weekend I spent with them, I recorded more than twenty hours of conversation. On Sunday night, when we were all exhausted, sitting in the kitchen, I said, “If Dylan were here now, do you have a sense of what you’d want to ask him?” Tom said, “I’d ask him what the hell he was thinking and what the hell he thought he was doing!” Sue looked down at the floor for a minute before saying quietly, “I would ask him to forgive me, for being his mother and never knowing what was going on inside his head.” When I had dinner with her a couple of years later, she said, “When it first happened, I used to wish that I had never had children, that I had never married. If Tom and I hadn’t crossed paths at Ohio State, Dylan wouldn’t have existed and this terrible thing wouldn’t have happened. But over time, I’ve come to feel that, for myself, I am glad I had kids and glad I had the kids I did, because the love for them—even at the price of this pain—has been the single greatest joy of my life. When I say that, I am speaking of my own pain, and not of the pain of other people. But I accept my own pain; life is full of suffering, and this is mine. I know it would have been better for the world if Dylan had never been born. But I believe it would not have been better for me.” I was struck by how very attached all these parents were to children who manifested shocking challenges. I wondered how they had all found so much meaning in parenting under apparently antithetical circumstances. And then I thought that all of us who have children cherish the children we have, with their inherent flaws. If some glorious angel suddenly descended through my living room ceiling and offered to take away the children I have and give me other, better children—more polite, nicer, smarter—I would cling to the children I have and pray away that atrocious spectacle. As one mother said when she interred the ashes of her severely disabled child, “Let me bury here the rage I feel to have been twice robbed: once of the child I wanted, and once of the son I loved.” In the same way that we test flame-retardant pajamas in an inferno to ensure they won’t catch fire when our child reaches across the stove, so these stories of families negotiating extreme differences reflect on the universal experience of parenting. I have yet to meet any parent who 30

Difference is ubiquitous; we have no thing more in common than our variance from the norm. Ironically, it turns out that our differences unite us.

hasn’t occasionally looked at his or her child and wondered, “Where did you come from?” Each of the ten kinds of difference I researched is siloed; there are only so many families dealing with schizophrenia, only so many families of children who are transgender, only so many families of prodigies. But if one recognizes that all these families are negotiating difference and posits that all such experiences are parallel, then it turns out that this a nearly universal phenomenon. Difference is ubiquitous; we have no thing more in common than our variance from the norm. Ironically, it turns out that our differences unite us.

MY OWN FAMILY I decided to have children while I was working on Far from the Tree: Parents, Children, and the Search for Identity. Many people said, “But how could you decide to become a father in the midst of writing a book about everything that can go wrong?” And I said, “It’s not a book about everything that can go wrong. It’s a book about how much love there can be even when everything appears to be going wrong.” l

MEET ANDREW ON OCTOBER 13, AT THE GAMECHANGER IDEAS FESTIVAL IN BISMARCK.

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Andrew’s research focuses on the intersections between politics and medicine in Colonial and Revolutionary America.

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ANDREW WEHRMAN ideas festival

Andrew Wehrman is a historian of early American history and the history of American medicine at Central Michigan University. His research focuses on the intersections between politics and medicine in Colonial and Revolutionary America. His current book project The Contagion of Liberty argues that popular demand for public inoculation during smallpox epidemics in the 1760s and 1770s infected Revolutionary politics and changed the way Americans understood their health and their government’s responsibility to protect it.

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HOW TO PREVENT AN EPIDEMIC LIKE THE AMERICAN COLONISTS DID by Andrew Wehrman

e look back to the United States’s founders for guidance on many things, but not usually for medical advice. Medicine in early America seems backward and frightening. Colonists

had very few hospitals. They, of course, had none of our modern technology, but they also didn’t know germ theory. They had no antibiotics and no conception of antiseptics. If you were sick in the eighteenth century, a physician would likely bleed you and perhaps offer a strong purgative to induce vomiting or diarrhea. If you survived all that, hopefully you felt better. Colonists who could not afford to see a doctor were often better off. Looking in hindsight at limitations in colonists’ medical knowledge blinds us to the ways in which they kept themselves well. Colonists suffered from epidemic diseases that are almost entirely unfamiliar to modern Americans thanks to vaccinations and modern medicine. Colonial Americans suffered from smallpox, cholera, yellow fever, typhus, measles, and scarlet fever. For the most part these diseases were epidemical—that is, outbreaks would in a city occur every decade or two. Boston, for instance, had epidemics of smallpox in 1721, 1730, 1752, 1764, 1776, and 1792. We normally think of these as unavoidable natural disasters. But if we focus on the gaps between those outbreaks, we can see that the colonists were quite vigilant about preventing disease and mitigating the human cost when they occurred. They didn’t need modern medicine to stave off diseases for decades at a time. The ways in which Colonial America prevented outbreaks of disease and then worked to stop epidemics provide lessons for modern Americans battling our own epidemics. Although so far we have no cures for emerging diseases like ebola or for epidemic crises like opioids and gun violence, studying Colonial Americans proves that you don’t need cures or perfect science to prevent or end an epidemic. What you need, and what these early citizens developed, is a set of principles and policies that leads to better community wellness. Colonists certainly did not always follow these nine rules, but when they did, they almost always generated healthy results: 1. VALUE AND EMPOWER LOCAL GOVERNMENT Beginning in the seventeenth century, colonists in Boston realized that the sporadic efforts of individuals or even groups of colonists reacting to crises was no substitute for sustained public effort and policy. By the beginning of the eighteenth century, Boston’s town meetings became longer and more substantive. They created a host of new positions: overseers of the poor, assessors, inspectors. The city council selectmen were similarly charged with active duties in the city. The Massachusetts General Court in 1699 passed “An Act for the Better Prevention of the Spreading of Infectious Diseases.” The act forbade any ship from coming into Boston that had infectious crew 34

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members or that had sailed from a port known to have an outbreak of disease. To enforce this law Boston needed educated inspectors who recognized symptoms and kept up with news of disease outbreaks around the world. Eventually this act led to the creation of quarantine hospitals, or pesthouses, to isolate infectious people from the town. These were built and staffed at the expense of the town, but individuals who wound up there might still have to pay for their care. 2. SUPPORT LOCAL NEWS MEDIA In 1704 the Boston News-Letter, the first continuously published newspaper in Colonial British North America, began. The newspaper was a crucial component of public health in Boston. Not only did newspapers print news and rumors of disease outbreaks locally and around the world, but they also printed medical debates and advertisements from doctors and for new medicines. Newspapers allowed readers to discuss policy issues and to hold their government accountable. Officials in Boston would also use the newspapers for official notices to warn the public there was an infectious family on Fish Street, for example, or later on in the century, to publish disease statistics and annual Bills of Mortality specifying and alerting people to the cause of death of residents. 3. HAVE AN OPEN MIND AND INVITE DEBATE (NOT BOMB THROWING) In 1721, despite the regulations in place, smallpox broke out in Boston. Reverend Cotton Mather had read interesting reports from the 35

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Royal Society in London about a new technique called inoculation, in which patients were purposefully infected with smallpox via a small incision in their arms rather than allowing it to occur naturally. The patients usually experienced a mild case of the disease and, most importantly, became immune to natural smallpox for life. While inoculation was new to Western medicine and the Royal Society, Mather excitedly wrote that he already knew about it before reading the reports. His African slave Onesimus had already told him of the technique, which had been used in East Africa for generations. Mather wrote in the newspaper encouraging others to inoculate. He was publicly ridiculed and worse. The only doctor in Boston with a medical degree, William Douglass, lambasted Mather in the press. He mocked Mather’s previous association with the Salem Witch Trials and the idea that an African could be in possession of advanced medical knowledge. But Douglass had some valid concerns, too: by inoculating, Mather was undermining medical and political authorities as well as Boston’s regulations against importing disease. The newspaper swelled with bitter debate as newspaper editors, including Benjamin Franklin’s brother James, took sides. It became so tense that one man threw a grenade into Mather’s house. Fortunately, it failed to explode. As the epidemic worsened, only one doctor in Boston, Zabdiel Boylston, was convinced by Mather to experiment with inoculation. Boylston, beginning with his own family, inoculated 242 people. 4. LEARN FROM EXPERIENCE In February 1722, once the active spread of epidemic had ceased, the selectmen of Boston collected and 36

printed in the newspaper the statistics from the epidemic and from the inoculation efforts. The numbers showed that the inoculated individuals had a much lower mortality rate (2 percent) than those who caught smallpox naturally (15 percent). The city again attempted to control the spread of infection, but a few years later, in 1730, there was another outbreak. The debate raged again, although not as violently, but the statistics again proved the effectiveness of inoculation. Newspaper publishers and the authors of medical guides and pamphlets began using these statistics to prove that inoculation against smallpox was not only effective but was, in fact, humankind’s greatest medical discovery. In 1736, after his son Francis died from natural smallpox, Benjamin Franklin became one of the leading advocates for inoculation in the colonies. He printed statistics from epidemics and inoculation efforts in newspaper and printed articles and guides on inoculation and healthy living generally in his Poor Richard’s Almanac. In 1759, he printed a brief instructional guide on inoculation and had it distributed free to the poor. Even Douglass changed his mind and began advocating for the regulated implementation of inoculation to prevent disease. 5. DESTIGMATIZE DISEASE The revelation that inoculation could prevent smallpox also helped prove that disease made no distinction among age, class, sex, or religion. Some had argued that inoculation was contrary to God’s will, because only the Lord should decide who becomes ill or well. Mather, Franklin, Douglass, and others argued instead that God gave us this preventative and that they were, in effect, denying God’s will if they failed

to use it. By the middle of the eighteenth century, as the evidence for the efficiency of inoculation increased, the religious qualms about the procedure decreased. Colonists also realized they could not stop epidemics by only inoculating the rich. If they did not look out for and treat slaves, for example, they might miss the beginning of a new outbreak. In a time when most medical authorities were men, women were the caretakers in their homes and the first to rush to help a family member or neighbor in need, so it was essential that they too be inoculated and educated in spotting symptoms in others. 6. ESTABLISH A THRESHOLD Inoculation for smallpox was effective, but a person undergoing inoculation remained infectious for about three weeks and could spread smallpox to others. For this reason Bostonians tightly regulated inoculations. In 1732, the Massachusetts legislature passed a law requiring the head of any family to alert the selectman when anyone came down with smallpox. The selectman then either moved the patient to a pesthouse or, especially if the victim was a child, fenced off the house from the street and placed a red flag in front to warn neighbors that smallpox was present. Newspapers would also inform readers about outbreaks of smallpox in town. In the Boston Town Meeting the threshold was established that if smallpox appeared in twenty households, the town would declare an epidemic and allow residents to inoculate themselves. 7. STOP BUSINESS AS USUAL When the threshold was met, as it was in 1752, the entire town shut down. The health of the citizens was more important than the momentary

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Some had argued that inoculation was contrary to God’s will, because only the Lord should decide who becomes ill or well. economy of the city. About six thousand of the nearly sixteen thousand people living in Boston at the time opted to leave the city. Thanks to the proliferation of arguments and statistics in favor of inoculation, many Bostonians chose to inoculate. In all 2,124 people were inoculated with only 30 deaths for a 1.4 percent mortality rate. Ultimately 5,545 Bostonians acquired natural smallpox and 539 died (9.7 percent). The port of Boston and general commerce were suspended for months as the disease progressed. Many businesses opted to relocate to Cambridge or other nearby communities. Franklin, lauding Boston’s approach, noted that “the trade of the town suffered only a short interruption, compared to what had usual in former times” from a prolonged epidemic. Merchant Joseph Greenleaf boasted that “the Small-pox never was so favorable in Boston before.” 8. SUPPORT THE POOR The 1752 epidemic once again proved the efficiency of inoculation, but it also left much room for improvement. Despite having a preventative at the ready, more than five hundred Bostonians died. Many of those were poor residents who could neither afford to flee nor to get inoculated. For the next decades Boston’s citizens, officials, and newspapers were once again vigilant about reporting and containing isolated outbreaks of disease. In early 1764, the number of smallpox cases began to rise, and the town braced for another citywide shutdown. A writer in the Boston News-Letter implored the town: “Let every reasonable Person consider his poor Neighbor.” In March 1764, the threshold was met and the selectmen informed people of Boston in the newspapers that in three days inoculation would commerce. More than twenty physicians teamed up with the overseers of the poor to treat the poor for free. Boston quickly became “one great hospital,” and thousands began inoculating.

Hundreds of people—including John Adams, who delayed his wedding to Abigail for the opportunity— rushed to Boston to be inoculated. General commerce in Boston was shut down for months. Harvard College had to cancel classes for an entire semester and then cancel commencement ceremonies in June as well. 9. COMMUNITY VIGILANCE Pulling off Boston’s general inoculation in the spring of 1764 required the total efforts of its residents. The city reimbursed doctors who inoculated the poor but also covered the costs for hundreds of others. The city hired nurses to care for the sick, carpenters to build hospitals and fence off areas under quarantine, and guards to enforce the rules. They paid bakers to feed the poor, landlords to house them, and weavers and launderers for clean linen and clothes, and the city even paid women to act as wet nurses for children who were either under inoculation or whose mothers were. Boston sent out inspectors to survey the extent of the disease and to count those under inoculation. The newspapers reported on all of this and kept the public updated. Residents counted on and trusted each other, but also held their neighbors accountable. They helped enforce quarantine rules, opened up their homes to strangers, and informed the public about illness in their households even when it may have been easier or more convenient not to admit it. They demanded aid be given to those who needed it and accepted it when given. Together they pulled through. In the epidemic of 1764, out of a population of 16,000, 700 caught smallpox naturally and 124 died (18 percent). A whopping 4,977 were inoculated, the largest single inoculation campaign perhaps in world history to that point, with only 46 deaths (1 percent). As the people of Boston proved in the eighteenth century, however imperfectly, solving an epidemic requires an all-in public effort. It can’t be on the shoulders of healthcare providers, or elected officials, or the press alone. It requires the public to overcome its apathy to ensure equal and continuing access to effective prevention and treatment for all. l

MEET ANDREW ON OCTOBER 13, AT THE GAMECHANGER IDEAS FESTIVAL IN BISMARCK. 37

GAMECHANGER IDEAS FESTIVAL THINKERS |

Dhruv explores the intersection of medicine, health policy, and economics.

GAMECHANGER IDEAS FESTIVAL THINKER:

DHRUV KHULLAR ideas festival

Dhruv Khullar, M.D., M.P.P., is a physician at NewYork-Presbyterian Hospital, a researcher at the Weill Cornell Department of Healthcare Policy and Research, and director of policy dissemination at the Physicians Foundation Center for Physician Practice and Leadership. He is also a contributor at the New York Times, where he explores the intersection of medicine, health policy, and economics. Dr. Khullar completed his training in internal medicine at the Massachusetts General Hospital and Harvard Medical School, and earned his medical degree at the Yale School of Medicine. He also received a Masters in Public Policy from the Harvard Kennedy School, where he was a fellow at the Center for Public Leadership.

FOLLOW DHRUV ON TWITTER AT @DhruvKhullar

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FINDING PURPOSE FOR A GOOD LIFE. BUT ALSO A HEALTHY ONE. by Dhruv Khullar

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My favorite medical diagnosis is “failure to thrive.” Not because patients are failing to thrive — that part makes me sad. But because of the diagnosis’s bold proposition: Humans, in their natural state, are meant to thrive. My patient, however, was not in his natural state. An insatiable cancer had claimed nearly every organ in his body. He’d lost a quarter of his body mass. His eye sockets cratered. His temples sunk in. I worried his ribs would crack under the weight of my stethoscope. “You know,” he told me the evening I admitted him. “A few years ago, I wouldn’t have cared if I made it. ‘Take me God,’ I would’ve said. ‘What good am I doing here anyway?’ But now you have to save me. Sadie needs me.” He’d struggled with depression most of his life. Strangely enough, it seemed to him, he was most at peace while caring for his mother with Parkinson’s, but she died years ago. Since then, he felt aimless, without a sense of purpose, until Sadie wandered into his life. Sadie was his cat. Finding purpose beyond oneself has long been understood as central to a good life. John Stuart Mill argued “those only are happy who have their minds fixed on some object other than their own happiness; on the happiness of others, on the improvement of mankind… followed not as a means, but as itself an ideal end. Aiming thus at something else, they find happiness by the way.” Victor Frankl, treating prisoners in Nazi concentration camps, believed that those who found meaning amidst unimaginable suffering were more likely to survive, suggesting “it was a question of getting them to realize that life was still expecting something from them.”

Nietzsche was more direct: “He who has a why to live can bear almost any how.” Purpose and meaning — what researchers call eudaimonic wellbeing — are separate from, and sometimes inversely related to, hedonic wellbeing or happiness. They constitute deeper, more durable states, while happiness — or feeling good — is superficial and transient. Being a pediatric oncologist, for example, is not a “happy” job, but it may be a very rewarding one. Raising a family can be profoundly meaningful, but parents are often less happy while interacting with their children than exercising or watching television. Only about a quarter of Americans strongly endorse having a clear sense of purpose and of what makes their lives meaningful, while nearly 40 percent either feel neutral or say they don’t. This is both a social and a public health problem: Research increasingly suggests that purpose is important for a meaningful life — but also for a healthy life. Having purpose is linked to a number of positive health outcomes including better sleep, fewer strokes and heart attacks, and a lower risk of dementia, disability, and premature death. Those with a strong sense of purpose are more likely to embrace preventive health services, like mammograms, colonoscopies, and flu shots. And people who score highly on measures of eudaimonic wellbeing have low levels pro-inflammatory gene expression; those who score highly on hedonic pleasure have just the opposite. Doing good, it seems, is better than feeling good. One study analyzed how having purpose 41

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Purpose is not something you have, or stumble upon—it’s something you build into your life. influences one’s risk of dementia. Researchers assessed baseline levels of purpose for 951 individuals without dementia, then followed them for seven years, controlling for things like depression, neuroticism, socioeconomic status, and chronic disease. Those who had expressed a greater sense of purpose were 2.4 times less likely to develop Alzheimer’s, and were far less likely to develop even minor cognitive problems. Another study followed more than 6,000 individuals over 14 years and found that those with greater purpose were 15 percent less likely to die than those who were aimless, and that having purpose was protective across the lifespan — for people in their 20s as well as those in their 70s. Having purpose is not a fixed trait, but rather a modifiable state: Purpose can be honed through strategies that help us engage in meaningful activities and behaviors, and reflect on what’s most important to us. This has implications at both the dinner table and the hospital bed. A recent randomized control trial compared the effect of “meaning-centered” versus “support-focused” group therapy for patients with metastatic cancer. Patients in the support groups met weekly and discussed things like “the need for support,” “coping with medical tests,” and “communicating with providers.” Patients in the meaning-centered groups focused instead on spiritual and existential questions, informed by the work of Victor Frankl. They explored topics like “meaning before and after cancer,” “what made us who we are today,” and “things we have done and want to do in the future.” Meaning-centered patients experienced fewer physical symptoms, had a higher quality of life, felt less hopeless — and were more likely to want to keep living. Other work suggests that school programs that allow students to discuss positive emotions and meaningful experiences may enhance psychological wellbeing, and protect against future behavioral challenges. But this isn’t how we usually operate. We instead assume that anxiety and depression are problems to be treated — not that emotional resilience and human flourishing are states to be celebrated. What’s most powerful about these conversations is not just that they can help cancer patients through treatment or teens build resiliency. It’s that they can help all of us. Their true value lies not in the clinical, but in the human: We should be asking ourselves and our loved ones these questions every day. During my most trying months of medical school, I met every Sunday evening with three friends. Phones off, lights 42

dim, wine glasses full. (It was more collegial and less romantic than it sounds). We shared the most challenging and most rewarding moments of our weeks. These conversations helped each of us glean — or perhaps create — meaning in challenging, sometimes traumatic, experiences: the death of a child we’d cared for; abusive language from a superior; the guilt of committing a medical error. It was in these sessions I chose my specialty, decided to apply to policy school, and vowed to reconnect with a lost friend. Meaning grows not just from conversation, of course, but also from action. That’s as true for youth seeking direction as it is for older individuals transitioning from one life role to another. One recent study randomized tenth-graders to volunteer weekly with elementary students — helping with homework, cooking, sports, or arts and crafts — or put them on a waitlist. Teens that volunteered had lower levels of inflammation, better cholesterol profiles, and lower body mass index. Those who had the biggest jumps in empathy and altruism scores had the largest reductions in cardiovascular risk. Engaging in other-facing activities may be most important for individuals whose identity is in flux, like parents with children leaving for college or employees preparing for retirement. A program run by Experience Corps, an organization that trains people over 55 to tutor children in urban public schools, has shown marked improvements in mental and physical health among tutors, including higher self-esteem, more social connectedness, and better mobility and stamina. (The kids do better too.) This work hints at an underlying truth: Purpose is not something you have, or stumble upon — it’s something you build into your life. Finding purpose is rarely an epiphany, not something you pick up at the mall or download from the App store. It’s a slow, arduous process — the product of frequent introspection, deep conversation, and intentional behavior. The key to a deeper, healthier life is not knowing the meaning of life. It’s building meaning into your life. Even if meaning is a four-legged friend named Sadie. l This essay was adapted from an article originally published in the New York Times. Copyright © 2018 by Dhruv Khullar.

MEET DHRUV ON OCTOBER 13, AT THE GAMECHANGER IDEAS FESTIVAL IN BISMARCK.

GameChanger Ideas Festival presents the theatrical premier of

A Beautiful HELL Poetry by Carol Kapaun Ratchenski Adapted for the Stage by Laurie J. Baker Developed and Presented by Theatre B

A Beautiful Hell is a story of the human journey from our mundane “normal”

through the unimaginable. It is a poetic and laser-focused journey of witnessing and supporting another human being through terminal illness, and the spiraling growth that great loss can bestow. It is the story of parents surviving the death of a child, children surviving the death of their parents, and human beings living until they die because it is all we can do.

September 7

October 12

Empire Arts Center Grand Forks, ND

Russell Reid Auditorium ND Heritage Center & State Museum Bismarck, ND

ideas festival

TICKETS ON SALE NOW AT gamechangernd.com

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Caitlin founded the death acceptance collective, The Order of the Good Death.

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CAITLIN DOUGHTY ideas festival

Caitlin Doughty is a mortician, activist, and funeral industry rabble-rouser. In 2011, she founded the death acceptance collective The Order of the Good Death, which has spawned the death positive movement. Her first two books, Smoke Gets in Your Eyes: And Other Lessons from the Crematory, and From Here to Eternity: Traveling the World to Find the Good Death, were New York Times best-sellers. She lives in Los Angeles, where she runs her nonprofit funeral home, Undertaking LA.

HAVE A QUESTION ABOUT DEATH, DYING, OR THE FUNERAL INDUSTRY?

Caitlin Doughty’s YouTube series, Ask a Mortician addresses these issues and more.

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TOOTHPICKS IN JELL-O by Caitlin Doughty

hough you may have never attended a funeral, two of the world’s humans die every second. Eight in the

time it took you to read that sentence. Now we’re at fourteen. If this is too abstract, consider this number: 2.5 million. The 2.5 million people who die in the United States every year. The dead space this process out nicely so that the living hardly even notice they’re undergoing the transformation. We’d probably pay more attention if no one died all year, and then on December 31 the entire population of Chicago suddenly dropped dead. Or Houston. Or Las Vegas and Detroit put together. Instead, unless a celebrity or public figure dies, we tend to overlook the necro demographics as they slip away into history. Someone must take care of these corpses, who have become useless at caring for themselves. Someone must pick them up from homes or hospitals and transport them to the places we hide bodies—mortuaries and coroners’ offices. In Dante’s Inferno the job fell to Charon, a shaggy-jowled, white haired demon who piloted sinners by boat across the River Styx into hell. At Westwind Cremation, that job belonged to Chris. Chris was in his late fifties, tan with a shock of white hair and sad bassethound eyes. He was always impeccably clean and wore khakis and a button-down shirt—California formal wear. I took to him immediately. He reminded me of Leslie Nielsen, star of the Naked Gun movies, which were my favorite as a child. Chris’s voice was slow and monotonous. He was a bachelor—never married, never had children. He rented a small apartment he would return to in the evening to eat a bowl of ramen and watch Charlie Rose. Chris was pessimistic and borderline curmudgeonly, but in a way that brought me happiness, like watching a Walter Matthau movie. Picking up a person who has died at home is known as a house call. Doctors may not make them anymore, but morticians are happy to come, day or night. Protocol in the funeral industry says that one person may go alone to pick up bodies from hospitals, nursing homes, and the corner’s office, but a team of two people must pick up a person who died at home. When a house call came in, I was to be Chris’s number two. 47

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I appreciated the two-person rule tremendously. The gurney was the most uncooperative, unyielding machine e’er created by man. It tried, in sinister fashion, to embarrass you in front of your boss by being clunky and useless at every turn. The gurney was the only thing in this world less cooperative then the dead bodies that were strapped to them. The thought on having to operate a gurney alone in someone’s private home was horrifying. The first house call I went on, a week into working at Westwind, was in South San Francisco. The deceased was Mrs. Adams, an African-American woman in her late forties who had died of breast cancer. To pick up Mrs. Adams, Chris and I hopped into the van, his version of Charon’s boat. This particular van, which Chris had owned for more than twenty years, was a white, windowless box of a vehicle, the kind they featured in televised public service announcements to remind children not to ride with strangers. Westwind once owned its own removal van— much newer, dark-blue, designed and outfitted with special feature for picking up the dead. But Chris liked routine. He liked his van. As we drove over the massive Bay Bridge connecting Oakland to San Francisco, I made the mistake of commenting on how beautiful the city looked that day. Chris was horrified. “Yeah,” he said, “But you live there, so you know once you get up close it’s just a noisy and dirty hell pit. I would be better if we just fire bombed the whole city. That is—if we even make it across.” “What do you mean if we make it across?” I asked, still adjusting to the concept of fire bombing. “Think about the way this bridge is built, Cat”—he called me Cat—“crammed up here on eighty-foot Douglas fir pillars just sticking in the mud. It’s like toothpicks in Jell-O, structurally. We’re just swaying up here. The legs could just snap in half like twigs any second, and we’re all dead.” I laughed at a slightly higher pitch than usual, glancing out the window at the long drop to the Bay below. We pulled up outside the Adamses’ home twenty minutes later with none of the pomp and pageantry of the funeral carriages of old. In lieu of plumed horses in a cortège, it was Chris and me in his twenty-year-old unmarked white van. Before we went in, I made Chris go over everything again. I wasn’t about to embarrass myself in front of this woman’s husband. “Don’t worry about it, Cat. A monkey could do this job. I’ll talk you through it.” As we got closer to the house, it became clear that we would not be dealing with just the woman’s husband. At least fifteen people were milling around outside, eyeing us suspiciously as 48

My first time removing a dead body from a home was going to be in front of forty crying people who hated me.

we walked up the front path to the door. When we walked through the front door we found ourselves in a high-ceiling living room, where at least forty people were gathered around a woman’s body. Like the scratch of a needle on a skipping record, their voices all went silent at once as the group turned to look at us. Oh great, I thought, the only two white people here have arrived to take their beloved matriarch away in our roving child-molester van. Chris, however, didn’t miss a beat. “Hello, folks, we’re here from Westwind Cremation & Burial. Is this Mrs. Adams here?” he asked, gesturing to the dead body in the center of the room. It was a pretty safe bet to assume that this was, in fact, Mrs. Adams, but the group seemed to appreciate the question. A man stepped out and introduced himself as Mr. Adams. Quick to prove myself useful, I asked in a solemn tone, “Were you her husband?” “Young lady, I am her husband. Not were her husband,” he replied, fixing me with a withering gaze, compounded by the forty other withering gazes from around the room. This is it, I thought. I’m done. I have shamed myself and my family and all is lost. However, Chris was, again, unfazed. “Well I’m Chris, and this is Caitlin,” he said. “Are we ready to take her, here?” At this point the family usually leaves the room, leaving the funeral-home employees to do whatever they do with the corpse to make it disappear. But this family wanted to watch us. This meant my first time removing a dead body from a home was going to be in front of forty crying people who hated me. This was the moment I learned the magic of Chris. He began talking me through the process. He explained how we were going to remove Mrs. Adams as if he were telling the crowd. “Now we’re going to pull the gurney right alongside the bed, and Caitlin is going to use that handle there to lower her

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side down. I’m going to take the sheet next to her head and Caitlin is going to take the sheet by her feet and slide it right underneath her. Caitlin is going to pick up her feet onto the gurney in one, two, three. Now she’s going to wrap the second sheet over her head and snap her in tightly.” This continued until Mrs. Adams was swathed and buckled securely to the gurney. The people in the room paid rapt attention to the process, following Chris’s voice step by step. I was grateful that he didn’t expose me as a fraud. I didn’t even really feel like a fraud. The way Chris explained things made me believe I actually knew what I was doing. Surely there had never been a time I hadn’t been an expert body shrouder. As we wheeled Mrs. Adams out the front door, her son came up to us. He was my age, and his mother was dead. He wanted to lay a flower on the gurney. I didn’t know what to say, so I blurted out, “She must have been a really amazing woman. Trust me, I can just tell about these things.” This was, of course, a lie. This was my very first house call and I didn’t know how to properly wrap the body in a sheet, forget measuring the vibe of the room to determine just how “amazing” a dead person was when they were living. “Um, yeah, thank you,” he said. Driving away from the house, Mrs. Adams rattling gently in the back, Chris assured me that I hadn’t actually screwed everything up forever. “Look, Cat, we see people at their worst moments. Maybe if someone’s buying a new car, or a new house, they want to be there. But what are they buying from us? Nothing, we’re charging money to take away someone they love. That’s the last thing in the world they want.” This made me feel better. Westwind’s two cremation machines

could handle six bodies (three in each retort) on a typical 8:30-5:00 day— thirty souls a week during busy periods. Each removal took at least forty-five minutes, far longer if the deceased was across the bridge in San Francisco. By all rights Chris and I should have been out fetching bodies constantly. Chris was out constantly, but often just to avoid Mike (our boss) by volunteering to run petty errands like picking up death certificates and going to the post office. I mostly stayed at Westwind and focused on cremation, since the majority of body pickups didn’t require a number two. Most deaths no longer happen at home. Dying in the sanitary environment of a hospital is a relatively new concept. In the late nineteenth century, dying at a hospital was reserved for indigents, the people who had nothing and no one. Given the choice, a person wanted to die at home in their bed, surrounded by friends and family. As late as the beginning of the twentieth century, more than 85 percent of Americans still died at home. The 1930s brought what is known as the “medicalization” of death. The rise of the hospital removed from view all the gruesome sights, smells, and sounds of death. Whereas before a religious leader might preside over a dying person and guide the family in grief, now it was doctors who attended to a patient’s final moments. Medicine addressed life-and-death issues, not appeals to heaven. The dying process became hygienic and heavily regulated in the hospital. Medical professionals deemed unfit for public consumption what death historian Philippe Ariès called the “nauseating spectacle” of mortality. It became taboo to “come into a room that smells of urine, sweat, and gangrene, and where the sheets are soiled.” The hospital was a place where the dying could undergo the

indignities of death without offending the sensibilities of the living. In my high school, my classmates and I had been told in no uncertain terms that we would not get into college and thus would never get a job and thus would end up unsuccessful and alone if we didn’t serve a certain amount of summer volunteer hours. So the summer between my sophomore and junior years, I signed up to volunteer at Queen’s Medical Center, a hospital in downtown Honolulu. They confirmed I was not a drug user and had decent grades, and gave me a hideous brightyellow polo shirt and a name tag and told me to report to the volunteer office. The volunteer department allowed you to select two areas of the hospital to rotate between from week to week. I had no interest in popular choices like the gift shop or the maternity ward. “Get Well Soon” balloons and crying babies seemed like a cloying, sappy way to spend the summer. My first choice was working the front desk at the intensive car unit, imagining a glamorous-nursewiping-fevered-brows scenario out of World War II. The ICU was not the thrill ride I had expected. Turns out, they never called the high school student in from the reception desk to assist doctors in lifesaving procedures. Instead, the job entailed hours of watching incredibly worried families wander in and out of the waiting room to use the restroom and retrieve cups of coffee. I had more success with my second choice, the distribution department. Working for the distribution department meant passing out mail and memos to different wings of the hospital or wheeling old women out to the front curb after they were discharged. But it also meant transferring dead bodies from wherever they had expired to the morgue in the basement. I coveted that task. The people who worked full-time 49

GAMECHANGER IDEAS FESTIVAL THINKERS |

in the department may not have understood my enthusiasm, but when there was a “code black” called for a corpse transfer, they would generously wait for me to arrive. In retrospect, it seemed odd that the hospital administration would say, “Sure thing, fifteen-year-old volunteer, you’re on corpse transfer duty.” I can’t imagine this was something they normally assign to young volunteers. In fact, I recall a fair amount of initial reluctance on their part— overcome by my successful begging. Kaipo, my direct supervisor, a young local Hawaiian man, would look at the board and declare in his thick pidgin accent, “Eh, Caitlin, you like come get Mr. Yamasake from Pauahi Wing?” Oh yes, I most certainly did want to get Mr. Yamasake. Kaipo and I arrived in Mr. Yamasake’s room to find him curled up in the fetal position on his immaculate white hospital bed. He looked like a museum mummy, with taut skin like brown leather. He was less than ninety pounds, desiccated by disease and old age. Either one of us could have lifted him onto the stretcher with one hand. “Dang, dis guy’s pretty old, yeah?” Kaipo said, Mr. Yamasake’s age surprising even a veteran of the corpse–transfer beat. The stretcher Kaipo and I had brought with us was actually a hollowed-out metal cage. We placed Mr. Yamasake inside before covering him with a stainless steel top, like a lid. A white sheet was draped over the whole operation. Kaipo and I left Mr. Yamasake’s room pushing what appeared to be an empty stretcher. We rolled into the elevator with regular hospital visitors holding their teddy bears and flowers, none the wiser about the secret corpse in their midst. (The next time you see two fullgrown adults moving an unoccupied stretcher in a hospital, think of Mr. Yamasake.) The others got off the elevator long before we did. Kaipo, Mr. Yamasake, and I continued down to the basement. The hospital presented itself as a positive place of healing with the latest technology and attractive Hawaiian art prints on the walls. Everything—the false stretcher, the secret morgue in the basement—was artfully designed to mask death, to distance it from the public. Death represented a failure of the medical system; it would not be permitted to upset the patients or their families. Kaipo and Chris from Westwind were kindred spirits in a way: two men of quiet dignity who transported the husks of the recently alive. To them it was a prosaic day job, while to the average citizen theirs was a task both mystifying and disgusting. A few weeks after our trip to the Adamses’, Chris and I took a house call in the Marina District of San Francisco at a fancy 50

The hospital was a place where the dying could undergo the indignities of death without offending the sensibilities of the living. home on a well-trafficked street. When we knocked, a dark-haired woman in her fifties opened the door. I gave her a big, sincere smile, having learned at that point that a sincere smile was more effective then faked sympathy. “I called you hours ago!” she shrieked. “Well, ma’am, you do know that it is rush hour and we were coming from Oakland,” Chris said in his soothing Chris voice. “I don’t care, Mom deserves the best. Mom would have wanted everything to be dignified. She was a dignified woman, this is not dignified,” she continued, still shrieking. “I’m sorry ma’am, we’ll take good care of her,” Chris said. We continued into a bedroom to find Mom. As we pulled out the sheet to shroud her, the woman hurled her body over her mother, wailing dramatically. “No, Mother, no, no! I need you, Mother, don’t leave me!” This is what raw human emotions should look like. It had all the signs: death, loss, gut-wrenching wailing. I wanted to be moved, but I wasn’t. “Guilt,” Chris mumbled under his breath. “What?” I whispered back. “Guilt. I’ve seen this so many times. She hasn’t visited her for years. Now she’s here acting like she can’t live without her mother. It’s bullshit, Cat,” he said. And I knew he was right. The woman finally extricated herself from mother’s corpse, and we were able to get Mom wrapped up and out the door. As we rolled the gurney out onto the busy street, people stopped and stared. Dog walkers halted and yoga moms slowed their baby carriages. They gawked at us as if we were detectives or coroners, pulling a body from a violent murder scene, not two mortuary workers handling a woman in her nineties who had died quietly at home in bed. For the few minutes it took Chris and me to roll “Mom” from her front door to the back of the van, we gave the dog walkers and yoga moms a cheap, manageable thrill. A whiff of depravity, a small taste of their own mortality. l

MEET CAITLIN ON OCTOBER 13, AT THE GAMECHANGER IDEAS FESTIVAL IN BISMARCK.

HUMANITIES NORTH DAKOTA WELCOMES MARK CLEMONS

MARK CLEMONS has over 30 years of experience in estate, financial and charitable planning. Mark serves on the Board of the Northwest North Dakota Community Foundation and on the Board of the Long X Arts Foundation. He was selected in the Fall of 2017 to join the inaugural class of “Change Network of North Dakota” developed by National Arts Strategies and the Bush Foundation to prepare participants to lead and support organizations and communities to be more inclusive and equitable. Mark and his wife, Kimberly, moved to Watford City from Puyallup, Washington in June of 2014. “... too often torn by division, our communities have the ability to find a common heartbeat by supporting the humanities. I look forward, with excitement, to serving on the board of Humanities ND and helping to facilitate and lead positive and thought provoking conversation that I’m confident will build diverse, tolerant and caring communities in North Dakota.”

We have ways of making you think. HND Board of Directors

Staff

CHAIR Elizabeth Sund, Minot VICE CHAIR Ann Crews Melton, Bismarck Bethany Andreasen, Minot Mark Clemons, Watford City Marilyn Foss, Bismarck John S. Heinen, Dickinson Eric L. Johnson, Grand Forks Leslie W. Peltier, Belcourt Carol Kapaun Ratchenski, Fargo Ken Schmierer, Ellendale Iris Swedlund, Velva Sarah Vogel, Bismarck

Brenna Daugherty Gerhardt, Executive Director Kenneth Glass, Associate Director Corby Kemmer, Development Director Kayla Schmidt, Program Coordinator Elizabeth Ehlis, Intern Michaela Granger, Intern

Humanities North Dakota is a partner of the National Endowment for the Humanities. The humanities inspire our vision of a thoughtful, respectful, actively engaged society that will be able to meet the challenge of sustaining our democracy across the many divisions of modern society and deal responsibly with the shared challenges we currently face as members of an interdependent world.

800-338-6543 info@humanitiesnd.org

humanitiesnd.org

SCHEDULE OF EVENTS

Grand Forks Schedule of Events All events at Empire Arts Center SEPTEMBER 6 7:00 PM Everything Happens for a Reason and Other Lies I’ve Loved: An Evening with Kate Bowler During this sit down interview, Bowler will talk about her faith, her cancer diagnosis, and her struggle to understand the American belief that all tragedies are tests of character.

September 7 7:00 PM

A Beautiful Hell This play explores the sorrow and joy of walking a loved one through a terminal illness.

ideas festival

Tickets available at gamechangernd.com

OUR MISSION

ideas festival

Our Founding Fathers believed in the importance and the power of ideas to change people’s lives. Our nation’s history has been a great adventure in ideas. The GameChanger Ideas Festival was created to continue this proud tradition and provide people opportunities to engage with and debate life-changing ideas, because democracy demands wisdom and vision in its citizens.

Bismarck Schedule of Events OCTOBER 12 6:30 PM

11:30 Break

ND Heritage Center & State Museum

11:55 Community GameChangers

A Beautiful Hell This play explores the sorrow and joy of walking a loved one through a terminal illness.

Medicine”

OCTOBER 13 Belle Mehus Auditorium Livestreamed at gamechangernd.com

8:00-9:00 AM Registration 9:00 Opening Remarks 9:15 Andrew Solomon, “Far From the Tree” Solomon discusses the means by which families accommodate children with physical, mental and social disabilities and how these unusual situations can be invested with love.

10:15 Break 10:35 Community GameChangers Learn about some of the people and organizations working to create positive change in our state.

10:45 Andrew Wehrman, “Revolutionary Medicine” Dr. Wehrman provides insight on the historical lessons we can learn from Colonial America.

Noon Dhruv Khullar, “Finding Meaning in Dr. Khullar believes finding purpose in life is essential when creating a healthy lifestyle. Here’s why.

1:00 PM Lunch 2:30 Community GameChangers 2:40 Ashton Applewhite, “This Chair Rocks: How Ageism Warps Our View of Long Life”

Applewhite uses stories and statistics to dispel myth after myth about late life. Change the way you envision your future.

3:40 Break 4:00 Community GameChangers 4:15 Caitlin Doughty, “Smoke Gets in Your Eyes & Other Lessons from the Crematory”

Doughty may be a mortician, but she knows how to put the “fun” in “funeral. Let’s talk about death.

5:10 Closing Remarks 5:20 Book Signing

OUR AUDIENCE

OUR THINKERS

The GameChanger Ideas Festival is for people who never want to stop learning and growing. People who value being part of a community of lifelong learners who thrive on seeing issues from multiple perspectives and believe in making thoughtful and informed decisions on critical issues. If you value curiosity and exploring topics you’ve never even thought about before, this event is for you. Police officers, school teachers, stay-at-home parents, engineers, mayors, business leaders—we are all students of life.

We invite people to our stage who challenge the status quo and strive to make changes to critical systems that honor our shared humanity. We believe that civil disagreement and debate are stepping stones for learning. The GameChanger Ideas Festival does not take political stances on issues. Instead we strive to offer a variety of viewpoints from people with both scholarly insight and hands-on knowledge. These aren’t just people with good ideas, but people who have put their ideas to action in the real world. 53

HUMANITIES NORTH DAKOTA

is a proud to announce our civics education initiative for high school students:

We the People The Citizen and the Constitution eeee

THE CURRICULUM

SIMULATED HEARINGS

The foundation of the We the People program is the classroom curriculum. It complements the regular school curriculum by providing high school students with an innovative course of instruction on the history and principles of U.S. constitutional democracy. The text covers these six units:

The We the People program’s culminating activity is a simulated congressional hearing in which students “testify” before a panel of judges acting as members of Congress. Students demonstrate their knowledge and understanding of constitutional principles and have opportunities to evaluate, take, and defend positions on relevant historical and contemporary issues.

ONE: What Are the Philosophical and Historical Foundations of the American Political System?

Findings show that We the People students are much more likely to:

TWO: How Did the Framers Create the Constitution? THREE: How Has the Constitution Been Changed to Further the Ideals Contained in the Declaration of Independence? FOUR: How Have the Values and Principles Embodied in the Constitution Shaped American Institutions and Practices?

- Be inclined to participate in politics - Respect the rule of law - Follow politics and enjoy talking about government and politics - Critically consume political news

FIVE: What Rights Does the Bill of Rights Protect?

- Be inclined to vote in presidential elections, local elections, and serve on a jury

SIX: What Challenges Might Face American Constitutional Democracy in the Twenty-first Century?

- Believe that it is their responsibility to be involved in their community - Feel that they could make their community better by working with others rather than individually - Become more tolerant of opposing political ideas

“Civics education is the cornerstone of democratic citizenship. Humanities ND is committed to keeping our foundations strong by investing in future generations of American voters through the We the People program.” - Brenna Gerhardt, Humanities ND executive director

AUGUST 12-14, 2018

WE THE PEOPLE TEACHER INSTITUTE This rigorous professional development program brings educators together to work with constitutional scholars to enhance classroom teaching. Free and open to all social studies teachers across North Dakota.

FIND OUT MORE AT HUMANITIESND.ORG

What gives your life deeper meaning and purpose?

How do we want to be governed and live in community? Our Founding Fathers believed in the importance and power of the humanities to change people’s lives. Indeed, our nation’s history has been a great adventure in ideas. Humanities North Dakota was created to continue this proud tradition. Our mission is to provide people opportunities to engage with and debate life-changing ideas because democracy demands wisdom and vision in its citizens. Formally, the HUMANITIES are the disciplines of HISTORY, RELIGION, PHILOSOPHY, LITERATURE, ANTHROPOLOGY, LAW, AND ETHICS. Taken as a whole, they seek to understand what it means to be human. For individuals, they are the tools used to explore the meaning and purpose of life. For societies, they help define how we want to be governed and the values we want enshrined in civic life.

HUMANITIES NORTH DAKOTA is an independent non profit organization dedicated to providing lifelong learning opportunities to the citizens of North Dakota. Established in 1974, we are not a state agency and do not receive state funding.

Donate and become a member of Humanities North Dakota today!

NON-PROFIT ORG US POSTAGE

HUMANITIES NORTH DAKOTA 418 E. Broadway, Suite 8 Bismarck, ND 58501

PAID

BISMARCK, ND PERMIT NO. 433

GET INFORMED. BE ENGAGED. CHANGE THE WORLD.

THE PURSUIT OF HEALTH & HAPPINESS September 6-7, 2018 Grand Forks, ND October 12-13, 2018 Bismarck, ND ideas festival

gamechangernd.com