May 26, 2020

Honor Thy Father and Thy Mother

By Kenneth Ring, Ph.D.

Normally, I am not the kind of guy who begins to blog by making reference to the Bible, much less to one of the ten commandments, so I have to tell you at the outset why this one starts with a title from Exodus. It's because I think I have to make some amends for an earlier blog.

I'll get to that in a moment, but first a little prologue is necessary.

In my last blog, I discussed some of the baneful effects of the pandemic on college-age or college-bound youths. In this one, I mean to consider some of the challenges faced by the elderly in coping with COVID. The young have had their future, at least in the short term, and possibly longer, blighted. But the old have no future save for the grave. Yet for far too many elderly people, COVID is only expediting their passage toward terrestrial oblivion. Some wags have even started to call COVID a boomer remover.

In traditional cultures, or even in former times in our own, elders were revered. However, nowadays in America, it's not exactly that they are reviled, but they are often disparaged, dismissed and neglected, which is in fact a type of elder abuse. It's not that the treatment of the old, especially the very old, constitutes a pandemic in its own right, of course, but it is rife, and seems to be becoming increasingly so. And now the tensions associated with COVID that health care workers have to endure on a daily basis may be making life for the elderly even more fraught and dangerous.

Consider: There was a time, and it wasn't even so very long ago, that the elderly continued to live in an extended family setting and when they became frail and infirm were cared for in the home until they died. In such homes, they were honored and sometimes even venerated. But with the decline of extended family homes in favor of isolated nuclear family arrangements, we typically no longer care for our own elderly loved ones ourselves. Instead, increasingly, they live alone; or when they get old enough or infirm or demented, we warehouse them until they die. That's the new American way of death for so many now because we have come to de-venerate the old. They are surplus people who no longer count for much. 

And these days, in the age of COVID, nursing and old age homes and other such facilities for the aged are among the worst places to live because COVID can be so easily transmitted there. Thus, the most vulnerable are also the most at risk because we already know that COVID is a disease that disproportionately targets the old. People like me. 

Now to return to my wish to make amends, let me remind you that in one of my earlier blogs, I jokingly made what I called my own "modest proposal" -- that it would be better if we could bump off people when they reached the age of three score and ten. I made the point that once you hit 70, you've joined the surplus generation; you mostly just take up valuable space and ultimately require vast sums, especially in the last years of your life, to sustain yourself until you die.

I still think a lot of needless suffering and medical expense could be eliminated if so many people didn't live so long, as more and more of us do these days, but of course I am not really proposing anything so monstrous as the institution of widespread mandated mercy killing. I am not a Nazi! On the contrary, the more I read and hear about what COVID is doing to the old, the more sorrow I feel. Life is hard enough when you get old; COVID is just making it orders of magnitude more difficult for them and many are dying once they get infected.

And at least some of their suffering can be traced to still another factor -- "elder abuse." You see, the old just don't matter as much as younger people or children. In a time of limited resources, the old get short shrift. As one geriatrician, Louise Aronson, recently observed in an article in The Atlantic:
"The problem is that when the impact of disease in a population is unknown, there's little incentive to develop treatments tailored to that group's needs. When the affected population is elders, the problem is especially bad: As we've already seen with the current crisis, many people say that elders are dying anyway and tend to blame old age itself for their deaths -- not a flawed system."
Aronson, who is also the author of a highly regarded book, Elderhood, about the problems of and discrimination against the old, goes on to delineate various ways in which the elderly are second-class citizens when it comes to medical treatment, a state of affairs that has just been exacerbated by the pandemic.

For example, protocols for the treatment of COVID have been developed for children and adults, but so far, not for the elderly, who constitute the most vulnerable demographic.

Furthermore, she points out this:

"Medical schools devote months to teaching students about child physiology and disease, and years to adults, but just weeks to elders; geriatrics doesn't even appear on the menu of required training. The National Institutes of Health mandated the inclusion of women and people of color in medical research in 1986, but it didn't issue a similar mandate for elders until 33 years later, in 2019. "The bias is so implicit, it goes unnoticed," one of my colleagues said of ageism in the American COVID-19 response and in medicine generally. But when you start to pay attention, you see it everywhere."

There are other, sometimes less obvious, problems that the old are more likely to have to deal with than younger people. For instance, although many older people have learned to use computers and other technological devices of our time, they, and especially the very old, often fall on the wrong side of the digital divide, making it harder for them to arrange for video visits with their doctors.

And doctors are beginning to see that older people often don't have the typical symptoms of COVID, but quite different ones that make it more difficult to diagnose and treat them. For younger people, the usual symptoms indicative of COVID are fever, an insistent cough and shortness of breath. But older adults may have none of these. Instead, they may just be sleeping longer or not eating. They may become apathetic, confused or disoriented -- or get dizzy and fall. In extreme cases, they can stop speaking and collapse. And when they come to the hospital and are tested, they have COVID. Older bodies just don't respond to illness and infection the same way younger people do, and drugs don't work the same way for older adults either. All this means that older people, the most susceptible to COVID, may be misdiagnosed and more at risk to die on that account.

And let's not forget what I already alluded to above -- the perilous situation many elders face who live in nursing homes or other facilities that are designed to care for the aged. Dr. Kathleen Unroe, a geriatrician at Indiana University, has observed that seniors living in such settings are going to get weaker because of greater immobility and may become confused on account of changes in routine. Plus, of course, living in close proximity to vulnerable others just increases the risk of uncontrolled COVID outbreaks, as we have seen.

All these factors just make the lives of older people more onerous and the likelihood of successful diagnosis and treatment much less than for younger adults. The result is that more older people die than would have been the case if modern medicine was not structured so as to de-value the elderly.

And even though the death rate from COVID is, relatively speaking, quite low, older people -- those 65 or older -- seem to account for about 80% of all COVID-related deaths, according to the figures I've seen. They may not be entirely accurate, but at any rate it is already clear that the great preponderance of deaths from COVID is taking place among the old.

Let's delve into this further by drawing on some more specific statistics. I'll begin with the area where I live, Marin County in California.

Our COVID cases are continuing to rise quite steadily and by the time you read this, they will exceed 400. We old timers make up about 20% of the population here, which is slightly higher than the national average of 15%. And so far my age group represents our fair share of COVID cases, also about 20%. But once you move to the number of hospitalizations, nearly half are old folks and when you come to death, old people comprise all of them -- 100%. Everyone else so far has survived; only the old have died here.

And the news is even worse if old people become so sick that they have to be put on ventilators. I don't want to numb you into insensibility by deluging you with more statistics, so let me just quote a one more set -- the mortality rate for older adults who have had to be put on ventilators. In one study, 70% of those over 70 died; in another study, 80% of those over 80 died. The death rate for younger people on ventilators is very much lower.

In sum, COVID is no friend to the old; it is often literally their mortal enemy.

Of course, statistics are bland fare. But when we are talking about death by COVID we are often talking about your grandfather or perhaps your aunt or even your mother. Or the dear relative of someone you know. As I write this, close to a hundred thousand people -- most of them old -- have died of COVID-related infections in the United States. And more will die in the future, and many more throughout the world have already died. Cynics might claim with some justification that they were due to die soon anyway. But still, many who died should not have had to die -- and why not? Because in medicine, as in life, we do not honor our fathers and mothers. Instead, we often abandon them or simply do not want to take the time to give the attention to them that we devote to younger people. So many old people these days die alone with no one to hold their hand, no one to ease their way into death, no one to weep at their bedside. All we can do is to take a moment to feel pity for those who have had to perish under the worst of circumstances -- and to remember them.

And maybe to resolve to make some changes in how medicine deals with the old. Louise Aronson has some hope for this, so to end this lachrymose blog on a positive note, let me conclude with some of her suggestions for how things may be made better for our elders:

"Everyone can help create a less ageist culture and improve individual institutions. Aging experts like myself are (for now, digitally) collaborating to devise elder-specific protocols for managing COVID-19. These protocols include essential information, such as the fact that body temperature runs lower in many elders, so a thermometer reading of just 99 degrees Fahrenheit in an 80- or 90-year-old might signal fever. In hospitals, these guidelines would include other, less obvious recommendations, such as also allowing patients with dementia or delirium -- whether or not they have COVID-19 -- to have a loved one by their side to limit terror, agitation, and the need for drugs proven to increase the time they will take up a much-needed bed. Such steps can boost early COVID-19 diagnosis and decrease suffering and complications in elders, thus benefiting all Americans by reducing the strain on our health-care system."

May 18, 2020

School's Out

By Kenneth Ring, Ph.D.
SACRAMENTO -- In the most sweeping sign yet of the long-term impact of the coronavirus on American higher education, California State University, the nation's largest four-year public university system, said on Tuesday that classes at its 23 campuses would be canceled for the fall semester, with instruction taking place almost exclusively online.
That was the opening paragraph of an article I read a couple of days ago, and it brought up a welter of troubling thoughts and poignant memories for me.

I spent most of the first sixty years of my life in universities. I attended Cal-Berkeley as an undergraduate before heading off to graduate school at the University of Minnesota for work on my Ph.D. During that time I also spent a year at U.C.L.A., prior to taking a job as an assistant professor of psychology at the University of Connecticut where I remained on the faculty for the next thirty-four years. (I am still a professor emeritus at that University.) Even after I retired and moved back to California, without being aware of it, I found myself living cheek by jowl next to a community college, and within a month of my settling here, I was lecturing there. So I am intimately acquainted with life on college campuses; it's in my blood. Tony Bennett may have left his heart in San Francisco; I left mine at UCONN.

I have vivid memories of life on my campus, and what came back to me the other day after reading that article about the shuttering of college classes in the fall in California was the period in late August just before students returned for the fall semester. For at least some of us academics, we parted company with T. S. Eliot because for us, it was August, not April, that was the cruelest month. Our summer idyll was ending; it would soon be time to get back to work and the sometimes drudgery of teaching. But for the students, it was different -- they were generally excited to get back to school, to connect with their old friends, to party (our school had a reputation as great party school), and to look forward to another thrilling basketball season. Parents bringing their kids to UCONN for the first time also added to the joyful atmosphere on campus. And, before too long, despite our own earlier crotchety grumblings, we academics were happily back in the swing of things. The energy that students brought back to campus was infectious and we all felt it.

But now? Now, to spare students, faculty and administrators from becoming infected, many campuses will effectively be closed for business this fall. The campuses will be silent and the students will have nowhere to go, nowhere to congregate, still stuck at home and obliged to continue their education as best they can by online learning.

Even if -- and this is still an if -- this condition doesn't persist beyond this year, it is nevertheless a devastating blow both to college students and to their institutions. So much will have been lost, has already been lost, and a number of colleges themselves may simply not survive. The psychological and economic impact of this pandemic on collegiate life can not be overestimated.

Besides, even if online learning has become more of a factor in college education in recent years, college is more than going to classes and taking courses. It is an entire experience made up of many things as well as an important rite of passage. High school students entering college for the first time enter a new world and by the time they leave, they will have been shaped by that world and by the people -- students and faculty -- they will have encountered while there. Life in fraternities and sororities is important in its own right. Collegiate sports are a vital part of college life and often an important, sometimes crucial, source of financial revenue. College is the one period between high school and the world of work that will follow which allows a person time to grow in important ways that he or she will never have again -- and that growth can only come from engagement with others. We humans are an affiliative species. Of course, we can learn many things on our own, but there are some things we can only learn from being with others. Without schools being open, this kind of learning cannot take place.

Nor can there be any way for students to gather in crowds -- to go to football games or basketball tournaments or soccer matches -- or even to their favorite pubs. Social media and zooming are no substitute for human contact, and that's what will be missing this fall on many campuses throughout the country.

I also think of all the high school students this year who were prevented from going through their graduation ceremonies with their friends and whose proud parents were therefore unable to witness and share in their children's moment of celebration. And for those students who had been looking forward to attending college in the fall, they now face only uncertainty. Colleges were already suffering declining enrollments before the pandemic hit, but tuition fees were not decreasing, and now colleges and universities are facing even more potentially calamitous futures.

According to one article on the effects of the pandemic on higher education:
The pandemic has had a devastating impact on the finances of colleges and universities, a large number of which were already struggling before virus-related closures. Many are concerned about growing signs that a large number of students will choose to sit out the fall semester if classes remain virtual, or demand hefty cuts in tuition.
Lucrative spring sports seasons have been canceled, room and board payments have been refunded, and students at some schools are demanding hefty tuition discounts for what they see as a lost spring term. Other revenue sources like study abroad programs and campus bookstores have dried up, and federal research funding is threatened.
Some institutions are projecting $100 million losses for the spring, and many are now bracing for an even bigger financial hit in the fall, when some are planning for the possibility of having to continue remote classes.
Administrators anticipate that students grappling with the financial and psychological impacts of the virus could choose to stay closer to home, go to less expensive schools, take a year off or not go to college at all. A higher education trade group has predicted a 15 percent drop in enrollment nationwide, amounting to a $23 billion revenue loss.
Yes, this is really a grievous time for college education in this country. One can only hope that with time it will recover, but what can't be recovered is what has already been lost as well as the losses and deprivations still to come.

Before I wound up studying near-death experiences, I was a social psychologist, and even though that was long ago and far away, I still can see things from that perspective. So I also worry not just about the future of colleges in this country, but about broader concerns stemming from our inability to gather with others. The lack of social contact on many college campuses this year is only an aspect of a much larger social deprivation that we are all experiencing, of course.

We are used not only to ordinary social contact, but to gathering in crowds -- to attend football games or tennis matches or rock concerts. But now, I read, major league baseball might resume in late July only to play in empty stadiums. Seriously. But without cheering crowds, that seems a literally empty gesture. It may provide more entertainment for sports fans at home and revenue for the players and owners, but it will do nothing for our need for social contact. And will tennis matches also be played without spectators in the stands? How about football stadiums with only phantoms in empty seats?

Quite apart from the lack of social contact is the lack of physical contact with people. As a one time social psychologist, this problem, it seems to me, has not received the attention it deserves. We humans also need physical contact with others. Of course, we can still get it from our pets -- and thank God for that -- but the costs of isolation from others can be severe, especially where the lack of touch is concerned. I remember early on during the pandemic reading about one woman who was found crying in a grocery store. When she was asked what was the matter, she sobbed that she had not been touched in ten days.

And it's worse. Nowadays, other people are sometimes regarded as phobic objects -- not only to be avoided for fear we can catch the virus from getting too close to them, but from fear that they may touch us. But we need touch and hugging; we need our daily dose of oxytocin.

Before the pandemic, I was used to seeing a longtime woman friend of mine for lunch every two or three weeks. We usually greeted each other with a warm hug. But now? I wonder whether we will ever be able to hug again. Instead will we merely bow like the Japanese do? Or perhaps just say "namaste" to each other? And what about handshakes? A simple pat on the shoulder? Where has all the touching gone?

Of course, one day the campuses -- at least on those colleges that remain -- will open again, and some surely will even hold in-person classes this fall, and one day we will be able to hug our friends and have other customary forms of physical contact with them. But for now -- and who knows how long "now" is? -- we will continue to live mostly isolated from one another, forced to rely on social media for contact, instead of our hands. We are social animals unable to socialize, stuck in our own homes, living in limbo, longing for contact, yearning for the end of our confinement but can only wait to live again in the world with our fellow humans.

May 5, 2020

In Praise of Idleness

By Kenneth Ring, Ph.D.

In Praise of Idleness is the title of a little essay the English Philosopher Bertrand Russell penned in 1932, three years before this idler made his debut into this world, which of course is neither here nor there, like this blog itself. But when this idler had turned into an indolent teenager and needed to find a way to pass his long summer vacation without having to resort to the indignity of working, he discovered the pleasure of reading books by Bertrand Russell, who quickly became his favorite philosopher, not that there was much competition as in those years I had barely heard of Schopenhauer and Nietzsche was simply beyond this Ken's ken. But Russell didn't write in the knotty prose favored by many modern academic philosophers; he wrote in a stylish accessible English, blessedly free of jargon and sprinkled with dashes of lively, wry humor.

I can still remember sitting on the outside steps of my parents' house one summer reading Russell's marvelously entertaining A History of Western Philosophy, which was my introduction to this vast treasury of Western thought. Russell's own erudition was obvious, but he was never pedantic; he was witty. He loved characterizing certain philosophers as "wicked," a charming way of describing their personal foibles and forays into what Russell thought was nonsense. He joked about Thales cornering the grape market, but also falling into some kind of a pit while thinking abstract thoughts, a humble and certainly ignominious beginning, Russell allowed, to Western philosophy. About such misadventures, Russell was fond of adding the stock exculpatory phrase, "That was not my fault." I picked up certain of Russell's other verbal tics, too, such as beginning my sentences with the phrase, "For my part," which was pure Russell-speak. (I always felt I should be smoking a pipe when using that phrase, but when I tried it as a young professor, I found that its pleasing aroma was far different from its acrid taste and soon gave it up for hard drugs.) And I loved the fact that Russell, who was a small man, was called by all his friends, "Bertie."

Of course, Russell was far more than a wit. He may have been small in stature but he was a giant figure in Western philosophy and mathematics for most of the 20th century and lived to the improbably great age of 97. He was even awarded a Nobel Prize in Literature. If you were to read books like his classic history of Western philosophy, his absorbing autobiography or his famous essay, Why I am Not a Christian, you can see why. He wrote books for the general public as well as fiendishly difficult books on the logical foundations of mathematics. He liked to joke that because he could write books like Principia Mathematica (with Alfred North Whitehead), which showed off his brain, he was entitled to write such popular potboilers as Marriage and Morals (he knew a bit about both having had four marriages and numerous affairs, some of them quite scandalous).

Well, clearly, I could write about Russell well into the night, but I haven't yet said why I am spending so much time on him to begin this blog. The answer is simple: Russell is in vogue again because of COVID. What is COVID but a period of enforced involuntary idleness? So, naturally, I find that people are rediscovering Russell's little essay on the virtues of idleness. I was seeing so many references to it in articles I was reading, I felt compelled to order the damn thing myself. It's on its way from Amazon, but, like everything else these days, and true to its title, it is taking its time. I am certainly looking forward to idling away my time with it soon. It'll be just Bertie and me again, like old times.

And, frankly, idleness is my both my middle name and my m├ętier during this caesura in time. As far as this pandemic goes, I have -- so far -- been one of the fortunate ones, as I well realize. Not only have I managed getting to avoid getting infected -- knock on silicon -- but I spend my days being busy doing nothing. It's not exactly what the Italians like to call the dolce far niente life -- a time of sweet indolence -- but it veers dangerously close. I used to have an extensive e-mail life of correspondence with a wide assortment of friends and professional colleagues, but after an initial flurry of feverish notes and inquires to make sure I was all right, my correspondence has dried up more quickly than a creek in August. No one has anything to say anymore because nothing is happening. So I have to find things to do to entertain myself. My girlfriend reads books aloud to me. She's just knocked off the whole of Pride and Prejudice (all 490 pages) and now she is reading the stories of Alice Munro to me. We watch films -- usually adaptations of Jane Austen's books -- or Netflix series like Unorthodox, or watch operas streaming from the Met. I have my own reading to do, too, of course -- anything by Mark Helprin and lately a horrifying book about a Polish member of the resistance during World War II who volunteered to enter Auschwitz in order to foment a resistance movement there. You really don't want to know more about that book. We all have enough to deal with these days -- except for me, of course -- to divigate into that hellish cauldron of unspeakable bestiality. For my part (ahem), I have nothing to deal with but the decay of my body and nothing do but wait along with everyone else.

But now I have suddenly found a new avocation. Inspired by Bertrand Russell's example, I am determined to use this time nonproductively to cultivate the arts of idleness. 

To begin with, I've been compiling a kind of bibliography of idleness -- a miscellany of books on the subject as well as some pithy quotes on the virtues and uses of idleness. Not long ago, a friend sent me an article in The New York Times by one Dwight Garner, the headline for which immediately appealed to me: "Celebrating Literature's Slacker Heroes, Idlers and Liers-In." Turns out there is already a fairly extensive literature devoted to the pleasures of idleness by those who ardently advocate the practice while lying in bed eating bonbons.

Garner begins by reminding us of a famous character in a 19th century novel by the name of Oblomov, a young nobleman who was incapable of taking any significant action. Instead, he simply stayed in bed. I've never read this novel, but from what I have learned about it, the only movement by this character in the first fifty pages take place when he moves from his bed to his chair. My kind of man.

Apparently, lying in bed has appealed to more than a few would-be sloths, some of whom managed to become quite famous nonetheless. There was G. K. Chesterton's essay, "On Lying in Bed," for example. Then there was Dr. Johnson's unassailable contention that "the happiest part of a man's life is what he passes lying awake in bed in the morning." And of course everyone knows that Proust wrote his masterpiece, In Search of Lost Time, while lying in bed. Another celebrated Frenchman, the philosopher, Jacques Derrida, was reputed to spend all day in his pajamas unless he had an appointment.

These days I would be inclined to alter Dr. Johnson's dictum to aver that my happiest hours are in the early morning while still dreaming in bed. The day usually goes downhill from there once I try to move, a mistake I hope soon to correct as I slide into deeper levels of slothfulness. And, according to what I've been told, lying in bed is also recommended for sex, though I gather that may require some exertion.

Getting back to Garner's article, he mentions a number of books that deserve to be in any aspiring idler's library. Among the titles he has made me aware of are: Robert Morley's In Praise of Obesity, Adam Phillips's On Being Bored, Eva Hoffman's How to Be Bored, Jenny Odell's How to Do Nothing, and Patricia Hampl's The Art of the Wasted Day. And for variety, you have Keith Waterhouse's primer The Theory and Practice of Lunch. Garner advises that you may want to provide plenty of time to nap between savoring these delectable how-to-do-nothing books. Moderation all things, even laziness, it seems, is the ticket.

Garner refers to still other books, but apparently, if you are really going to be lazy and want to read only one book, then it is the indispensable 2005 Tom Hodgkinson classic, How to Be Idle. According to what I've read, it was a near best seller in its day, spawned an almost cult-like following among dedicated idlers, and is regarded by many as the definitive book on the subject.

Here is a bit of what Garner has to say about this Bible for the idling class:
"This book seeks to recover an alternative tradition in literature, poetry and philosophy, one that says not only is idleness good, but that it is essential for a pleasurable life," Hodgkinson writes in his preface. "Where do our ideas come from? When do we dream? When are we happy? It is not when staring at a computer terminal worrying about what our boss will say about our work. It is in our leisure time, our own time, when we are doing what we want to do." He recommends not clicking on news radio upon waking. He nails me entirely when he writes, "A certain type of person feels it is their duty to listen to it, as if the act of merely listening is somehow going to improve the world." He is the laureate of sleeping in. "The lie-in -- by which I mean lying in bed awake -- is not a selfish indulgence but an essential tool for any student of the art of living, which is what the idler really is. Lying in bed doing nothing is noble and right, pleasurable and productive."
Although many people have condemned idling as a mere waste of time rather than as a resource for using time well, Hodgkinson can find considerable support from some eminent personages who, like Russell, have touted its value and even its necessity. Consider some of these quotes I have assembled from just a quick cursory perusal of what you can find for yourself on the Internet:

Idleness is an appendix to nobility -- Robert Burton

The condition of perfection is idleness: the aim of perfection is youth -- Oscar Wilde

The exquisite art of idleness, one of the most important things that any university can teach -- Oscar Wilde

One of the commonest characteristics of the successful man is his idleness, his immense capacity for wasting time -- Arnold Bennett

It is in our idleness, in our dreams, that the submerged truth sometimes comes to the top -- Virginia Woolf

As peace is the end of war, so to be idle is the ultimate purpose of the busy -- Samuel Johnson

Far from idleness being the root of all evil, it is rather the only true good -- Soren Kierkegaard

Well, I think I have provided enough here to convince you that, if your circumstances permit, the cultivation of idleness may be one of the best ways for us to navigate our way through this pandemic. As bad as it is and will be, it still provides us with a golden opportunity to savor life in the slow-mo lane. For my part (sorry!), I know I am looking forward to my reunion with Bertie Russell once his book arrives and I can get cracking on my idleness curriculum, which I plan to follow rigorously while in bed. And once I've finished Russell's primer, I feel I will then be ready to move on to the essays of the man G. B. Shaw called "The Incomparable Max," the peerless Max Beerbohm whose life of dilatory idleness set such a high standard that one can only marvel at but never hope to achieve. Still, as Browning said, a man's reach must exceed his grasp, or what's a heaven for? Even we idlers are not without our own aspirations and idler heroes.

But that's enough for now. It's time for my nap.