Chapter 9 of Diseasing of America, in which Stanton analyzes the meaning of America's larger attitudes towards addiction. He notes that while constantly harping on treatment of loss of control of alcohol, drugs, and other habits Americans nonetheless display more of these problems than virtually any other society. Stanton takes on some related incongruities, like America's stratospheric murder rate and poor birthing outcomes, as well as Halloween candy scares, rampant childhood obesity, and the role of TV viewing in societal problems. He traces all of these to self-fulfilling anxieties that characterize the American way of life. He ends this chapter with eight reasons why Americans are enmeshed in loss-of-control experiences the diseasing of America.
In: Peele, S. (1989, 1995), Diseasing of America: How we allowed recovery zealots and the treatment industry to convince us we are out of control. San Francisco: Jossey-Bass.
Diseasing of America
9. How We Lost Control of Our World
In worrying about legendary maniacs, we ignore real threats.... In addition, the urban legends foster fear and mistrust, jeopardizing our sense of community. Once people believe that their world contains dangerous maniacs, they are likely to withdraw into the safety of privacy and anonymity.
Joel Best, "The Myth of the Halloween Sadist"
I hate it as I'd hate a little drug habit fastened on my nerves. Its influence is the same but more insidious than a drug would be, more demoralizing. As feeling fear makes one afraid, feeling more fear makes one more afraid.
Mary MacLane, I, Mary MacLane
THE PARADOX of the American addiction treatment industry is the tremendous growth it maintains without demonstrating that it works. In the case of alcoholism, the treatment industry first convinced us that alcoholism is a major problem and now persuades us that the problem is ubiquitous. This problem augmentationand not any evidence the industry has offered that it can stem alcoholism or treat it effectivelyserves as the justification for the entire industry. The alcoholism industry thus presents a model of growth for any other industry that would carve out a niche in the mental health marketplace. The drug abuse industry is another case of the success of futility. We have spent successive fortunes on campaigns against drug useyet inner-city addiction and drug degradation achieved their major gains in urban ghettos only after we targeted drug abuse as a major social problem.
The addiction treatment industry is an expression of larger trends in American society. The principal trend has been our failure to stanch every social problem associated with the underclass that has evolved in the United States. Rather than address the fundamental social issues underlying ghetto deterioration, addiction policies speak to primarily middle-class anxieties. Problems rooted in ghetto life, in addition to substance abuse, include violence, childhood obesity, and the poor health of the fetus and newborn in America relative to every other industrialized nation in the world. And although these problems are worst in the ghetto, middle-class America also suffers from a version of each problem more severe than those found in other economically advanced countries.
Moreover, the addiction industry expresses the sense of loss of control we have developed as a society, an anxiety brought on by our utter incapacity to alter the trends over which we are so distraught. We have simply proved incapable of identifying correctly the sources of our most dire problems, and our tendency instead is to respond to our anxieties. Our fears themselves have now absorbed our attention to the point where they endanger our individual mental health and our health as a society. Our fears for our children, among other fears, affect us so much that we can no longer carry on a community life in the United States. Yet the failure of community leads to greater alienation, health problems, and the kind of violent and addictive relationships we examined in the previous chapter. Americans as a group now share some of the traits said to characterize mental illness, such as a terror at something nameless that we cannot shake.
Is the United States Worse Off Than It Used to Be, or Than the Rest of the World?
In order to get a handle on our social problems, we need to evaluate how bad these problems are, compared with America in the past and compared with the rest of the world. When our terror becomes unmanageable, we need to examine its realistic basis; perhaps the problem about which we are concerned has actually improved over time or isn't as bad as it is in other places. I believe that we badly overstate some of our problems, especially alcoholism and drug abuse, as well as such newfound problems as PMS and postpartum depression.
From the other side, I think we suffer more than we realize from a lack of sense of community and from our failure as a society to attack social problems. I believe that we are creating problems for ourselvesmany related to addictionand that more and more Americans feel themselves in the throes of one or several such compulsions. As we have seen, deciding one is addicted is a complicated process, entailing that one see oneself as being out of control of one's habits. And Americans do seem to feel that they are more out of control of their lives than they have felt in the past. This loss of controldespite all claims about the discovery of new biological causes of menstrual discomfort and genetic sources of alcoholism, depression, anxiety, and other conditionsis principally a social and psychological phenomenon.
Problems that we may overstateand that have a large subjective element to themare drug addiction and alcoholism. The signs are complicated, however. Americans' drinking has decreased in recent years, and it comes nowhere near the high per-capita levels of colonial and postcolonial America or of many European countries (like Belgium) that nonetheless do not consider alcoholism a serious problem. Americans use less cocaine and narcotics per capita today than they did at the turn of this century (when Coca-Cola contained a substantial dosage of cocaine, and when narcotics could be bought everywhere at drugstores and from street medicine salesmen). As we approach 1990, middle-class Americans use less cocaine than they did in the early 1980s, and kids are smoking less marijuana than they did in the 1970s. Drug experimentation in the United States is fairly common, although compulsive drug use is rare among high school and especially college students and is far from common in the average American community.
Despite the overall decline in alcohol consumption, drunkenness generally continues at a high level among adolescents and young adults in America. Ghetto, minority communitiesparticularly such minorities as Native Americans, Eskimos, Hispanics, and blackshave a high incidence of alcoholism. Furthermore, drug abuseespecially of the most destructive, antisocial kindis rampant in urban black and Hispanic communities. Runaway addiction in our inner cities, combined with smaller pockets of middle-class abusers, places our overall addiction rates far ahead of those for all European nations, even thosesuch as Holland, England, and Swedenthat have witnessed increased drug addiction in the 1970s and 1980s. For example, cocaine abuse did not become widespread in Europe (as many originally predicted), and crack use is still practically unknown there. As in the case of heroin, cocaine abuse will lag far behind in Europe for years, and then will follow the American lead in only a far milder way.
Thus, we see a mixed picture of high levels of drug use and drinking in some communities and in some groups of young people, combined with most young people maturing out and most middle-class communities becoming more abstemious. Overall, Americans do not drink and consume narcotics or cocaine as much as they have done at peak levels in the past. Despite these data, however, more Americansand particularly young Americanseither declare themselves or are declared by others to be drug- or alcohol-dependent. For example, although alcohol consumption in the United States declined between 1977 and 1987, AA membership doubled during that period. (AA's census figure for the U.S. in 1987 was 775,000; its estimated 1988 census figure is 850,000.) Furthermore, a government epidemiologist declares, this paradox will persist: "Despite moderating per capita alcohol consumption nationwide, the treatment of alcoholism and other chemical dependencies will remain a growth industry well into the foreseeable future."
THE DECLINE OF A BLACK COMMUNITY
As we saw previously, cocaine use has dropped overall but has increased in the inner city. This jump in ghetto usage of cocaine has been of the most potent forms of the drug, used in the most addictive style, and is accompanied by the greatest violence. While middle-class users do shop for crack in inner cities, their usage patterns are typically more moderate and less often accompanied by the violence, addictiveness, and social disintegration that mark innercity drug use.
One example of this process is the District of Columbia. Over the past two years in Washington, an intense police crackdown has led to a rate of twenty-one drug-related arrests per thousand D.C. residents. Nonetheless, drug use and related crime have increased, and constitute 60 percent of all crime in the city. The district prison is the most crowded in the United States; its population has increased 50 percent in the last five years, and a hundred more prisoners enter the system each month than leave it. Treatment facilities are likewise overloaded, and drug users referred to the system regularly leave treatment without completing the program and with no further follow-up. While federal drug expenditures in the 1988 fiscal year amounted to about $1.5 billion to be used for treatment and prevention resources and facilities, this figure translates into only about fifty hospital beds for drug treatment in D.C.a small percentage of the addicts in the City. Washington, D.C., is today overwhelmed by drugs, and drug-related violence is a constant presence in the lives of inner-city residents. And however extreme D.C. is, it is more or less typical of nearly every major U.S. city with a sizable black ghetto, including Detroit, Philadelphia, Boston, New York, Los Angeles, Providence, Hartford, Chicago, and Omaha.
Two Things Are Worse in AmericaObesity and Violence
Unlike the ambiguous cases of alcohol and drugs, which large parts of the American population rely on less, one behavioral/addictive problem is clearly growing worse. This is obesity, the appetitive behavior thatparticularly for the youngmay be the most out of control. It is odd that exactly at this time, the scientific community is beginning to accept the view that obesity is inherited. Yet several crucial aspects of obesity cannot readily be explained from a genetic standpoint. For example, obesity is highly related to socioeconomic status (SES). In a study in three Eastern cities, girls from a lower socioeconomic group were obese nine times as often as those from a high SES group. In addition, changing life circumstanceslike moving ahead socially or professionallyare associated with weight loss. Finallyand most important of allobesity has increased dramatically for children:
Data from four national surveys indicate pronounced increases in the prevalence of pediatric obesity in the United States. [including, since the mid-1960s] a 54% increase in the prevalence of obesity among children 6 to 11 years old and a 98% increase in the prevalence of superobesity.
How can the doubling of superobesity in children be explained genetically? Whatever role genes play in obesity seems to have been overridden by a general trend toward fatness in America. What might help to explain this phenomenon is the strong relationship between obesity and television viewing discovered by two researchers at the New England Medical Center, William Dietz and Steven Gortmaker, who have been tracking pediatric obesity. These investigators have shown that television viewing actually causes obesity: "Television viewing precedes obesity, even when controlled for confounding variables,. the relationship is unidirectional [obesity does not cause TV watching],. a dose-response effect occurs [the more TV you watch the fatter you get], and.a mechanism exists by which this association can be explained.
Thus we have decided that obesity can't be controlled because it is largely inbred at the same time that childhood obesity has skyrocketed, even as our society is ostensibly undergoing a physical fitness craze. Supposedly, Americans are more concerned with fitness than ever before; yet our kids are fatter than ever before (as well as frequently using drugs and alcohol). We are unable to get a handle on physical fitness for our society as a whole, and our health messages seem not to be reaching most of those with the worst health behaviors. The economic constraints that many Americans face, the decline in regular physical activity, the greater reliance on electronic entertainments, the radical increase in fast-food consumptionall make young people fatter, no matter how many articles about health appear in our magazines and how many health clubs open.
One other area in which the United States is doing worse than other countriesand increasingly sois our level of violence. In the previous chapter, we saw that one response to wife abuse has been to ease the proscription on wives killing husbands. Instead, we might consider that all this family violence takes place in a very murderous society. The homicide rate in the United States is ten times that of the urban areas of Western Europe. This is a worrisome problem, one that presumably could attract as much attention as drug addiction and spouse and child abuse (which, of course, contribute to murder statistics). Moreover, murder is most often committed in the groups among which we noted that family abuse is greatest, like black Americans, although murder is more common among white Americans than among Europeans.
This formulathe problem is greatest for underprivileged Americans, but is nonetheless greater among the rest of us than in comparably advanced, industrial societiesholds for drug abuse, obesity, child abuse, and other problems discussed in this chapter, including infant mortality and teen pregnancy and motherhood. More noteworthy about the United States than any individual social problem, however, is the larger dread that holds us captive when we contemplate our world and our children's world. And this fear is crucial to all our other problems and the possibility that we can find solutions for them.
We Have Nothing to Fear So Much as Fear Itself
A 1987 tract, When Society Becomes an Addict, claimed that we live in an addictive world, that our entire society is predicated on addiction and denial, and that therefore we need to implement a massive twelve-step program for everyone, making the government a kind of extension of AA. To see addiction everywhere and to decide that what we need is more AA fervor in order to achieve "recovery" as a society is so badly to miss the sources of addiction as to exacerbate what already makes the United States a world leader in addiction. America's problem is not that it refuses to see its addictionsit sees too many. We fear so many things that already too much of our society's ameliorative energy goes toward warning people against and protecting them from the many addictive dangers we have discovered.
Given how extensive the addiction treatment industry already is, why, then, do we continue to have so much to fear? The problems this book discusses all seem to be worsening, to judge from treatment activity and public service announcements and therapy advertisements. More victims of the various addictions and loss-of-control syndromessuch as gambling, compulsive shopping, PMS, postpartum depression, and, of course, drinking and drug takingare constantly being treated, yet we become more hysterical about all of these problems as each year goes by. What accounts for the paradox that as we expand our treatment facilities and public responsiveness we perceive our problems as less manageable? The addictive cyclerelying more on something as it brings us less satisfaction and successdoes indeed seem to typify our society, but mainly that part of it represented by the addiction treatment industry.
The never-ending cycle of claiming that there is more of a problem than we thought, then investing more resources in combating it, then reassessing the problem as being worse than we originally suspected so that it requires more resources starts, of course, with alcoholism. In 1940, a leading alcoholism expert declared, "Over 100,000 persons are suffering from alcoholism in the U. S. today." In 1946, an expert at Yale claimed that "there are in this country more than a million excessive drinkers. " In 1956, the Quarterly Journal of Studies on Alcohol estimated there were 5 million alcoholics; in 1965, the National Council on Alcoholism estimated 6.5 million; the NCA raised its estimate in the 1970s to 10 million. By the 1980s, the figure most often quoted was 15 million American alcoholics. In 1986, advertisements for Dennis Wholey's book The Courage to Change claimed that "there are 20 million alcoholics in the United States" and that "80 million Americans, one in three, are directly and tragically affected by this insidious disease."
In 1972, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) claimed in its Annual Report to Congress that "alcohol abuse and alcoholism drain the United States economy of an estimated $15 billion a year." In 1983, despite millions more in expenditures, the NIAAA estimated the costs of alcoholism to have increased almost eightfold, to $116 billion! One would think that such a dismal performance would cause Congress to cut back its mandate for alcoholism treatment and prevention, especially since alcoholism treatment has now become a major private industry. Instead, of course, the federal government continues to increase its expenditures in this area, despite which the National Council on Alcoholism and other alcoholism lobbying groups are predicting a steady rise in the financial toll taken by alcoholism.
Our history of combating drug abuse is no better. Each president since Nixon has had his own war on drugs. Nixon's and Carter's wars concerned primarily heroin, although new drug waves hit American cities after each claimed victory over drugs. Reagan's war, announced in 1982, was directed at cocaine. Yet cocaine supplies are more abundant and cheaper in the United States today than when Reagan's war began. Cocaine and crack addiction has visibly increased in most American cities. Identifying and combating drugs as a major social problem has not eliminated, reduced, or even held the problem at the earlier levels that were deemed unacceptable! By fiscal year 1989 the federal government spent $4 billion in its onslaught against drugs. Because even this massive expenditure had negligible effect, George Bush sought to add to Ronald Reagan's $5 billion request for the 1990 fiscal year, although not as much as the $6.5 billion Congress proposed for its war on drugs. The new federal thrust in combating drugs emphasizes treatment and such new tacks as civil penalties for drug users. At the same time, the money spent to destroy overseas supplies and to interdict drug imports also has increased radically, as has the involvement of the U.S. militaryin the form of the Coast Guard and the National Guardin these efforts.
The self-exacerbation of addictive problems is closely tied to the self-exacerbation of fear. The more we fear a problem, the more we worry and warn people about it, the more instances of the problem we find and the greater our perception of the danger. The process is one of a progressive sense of loss of control; the greater the number of things we discover to be afraid of, each of which individually inspires progressively more fear, the more depressed and frightened we become. Indeed, the reported incidence of both depression and anxiety are increasing, just as more people enter treatment for each and just as we boast of remarkable breakthroughs in treatment for each. What explains this process whereby we claim greater knowledge at the same time as we experience diminishing control in almost every area of behavioral and emotional disease?
Infant Mortality and Defects
As a case study of our failure to deal successfully with what we identify and treat confidently as a medical problem, let us consider infant mortality, birth defects, and related dangers for the newborn. Drinking and drug taking during pregnancy have been reported since the 1970s as major causes of all these problems. In the mid-1970s, for example, fetal alcohol syndrome (FAS) was identified, and in 1981 the U.S. surgeon general warned that pregnant women should never drink. In 1986, New York Times health writer Jane Brody stated, "An estimated 50,000 babies born last year suffered from prenatal alcohol exposure." Brody described FAS as "growth retardation before and after birth... facial malformations, including small, widely spaced eyes... brain damage, including an abnormally small head and brain" and claimed that "the fetal damage wrought by alcohol occurs independently of the effects of smoking, poor nutrition, poverty, illness and exposure to other drugs."
But, Brody indicated, most cases of prenatal alcohol damage go undetected. "Experts estimate that for every child with FAS, at least 10 others have more subtle and often unrecognized alcohol-caused problems. Indeed, prenatal alcohol exposure may turn out to be the primary cause of learning disabilities and hyperactivity." More chillingly, "there is no known safe level of alcohol intake during pregnancy, " and "even a small amount of alcohol consumed at the wrong time may affect fetal development adversely.. Even drinking before pregnancy (as little as one drink a day) may have an untoward result" (emphasis added). If even drinking casually before a woman becomes pregnant can maim a fetus, it is no wonder that many American mothers have panicked about their drinking! Meanwhile, American concern over drinking during pregnancy has not been matched by that in any European countryand yet virtually all of these countries have better birthing outcomes than the United States.
There are strong reasons to be skeptical about all of Brody's key points. One research team led by British physician Jeremy Wright found no cases of FAS among 903 women, although some drank quite heavily during their pregnancy. The authors concluded that FAS "is a rare disease . associated with pathologically heavy drinking." Another study, conducted with 1,690 mothers by Roy Hingson and his coworkers at Boston City Hospital, found that "neither level of drinking prior to pregnancy nor during pregnancy was significantly related to infant growth measures, congenital abnormality, or features compatible with the fetal alcohol syndrome." What did predict abnormally low birth weights and other deficiencies reminiscent of FAS were lower maternal weight gain and smoking either marijuana or tobacco. The authors noted "the difficulty in isolating and proclaiming single factors as the cause of abnormal fetal development"; instead, an overall life-stylecombining drinking, smoking, and drug usein most cases seemed to lead to infant abnormality.
Two FAS researchers at Boston UniversityHenry Rosett, a psychiatrist, and Lyn Weiner, a public health specialisthave disputed warnings that pregnant women must abstain from alcohol. Surveying their own work and that of over four hundred other FAS investigations, Rosett and Weiner found that all cases of FAS occurred among chronic alcoholics who drank heavily during pregnancy. The investigators also found that women can reverse the damage to their fetus from alcohol at any point during pregnancy by cutting back or eliminating drinking. They concluded, "the recommendation that all women should abstain from drinking during pregnancy is not based on scientific evidence."
It might seem that we would wish to scare pregnant women about drinking even the slightest amount of alcohol (as Jane Brody and the AMA do), in order that they not undergo even the slightest risk that comes with drinking. But Rosett and Weiner found, on the contrary, that current FAS education is overly alarmist and stressful to expectant parents. In these researchers' view, the most common problem from drinking during pregnancy today is the stress-related effects that women suffer from their regrets over drinking minute doses of alcohol. The authors have described in interviews, for example, cases where women phone in hotlines hysterical because they inadvertently ate some salad with a wine dressing!
Prenatal care is certainly important for healthy childbirth. Yet our new information on dangers to the fetus and emphasis on abstinence during pregnancy seems not to help us bear healthier children. The larger problem is that the promulgation of FAS information and recommendations that women quit all drinking and drug taking does not affect the women who are most likely to abuse alcohol and drugs. These same women receive little or no prenatal health care, eat worse and take worse care of themselves in every way during pregnancy, and have high rates of infant mortality. Indeed, World Health Organization pediatrician and epidemiologist Marsden Wagner has found that prenatal care improves birth outcomes only up to a certain point. The most crucial factor in successful birthing is, instead, community supports for the expectant mother. America rarely offers such supports, particularly for the highest-risk infants and mothers.
The United States ranks twenty-second among nations in preventing infant mortality, behind not only European nations, Australia, and Japan, but Bermuda and Singapore as well. In the early 1980s, the infant mortality rate declined in the United States as it did in other nations. However, in the mid-1980s, infant mortality leveled off in the United States while remaining substantially above the European rate. At the same time, over the past twenty-five years, physical and mental birth defectsof the type some attribute to drug and alcohol usehave doubled in the United States. Dr. Mary Grace Kovar, an analyst at the National Center for Health Statistics, remarks, "Regardless of the exact numbers, we are seeing real increases in children with some form of handicap, and this is resulting in a substantial burden to society, a burden that will increase with time."
Both infant mortality and deformed neonates are tied to teenage pregnancy. Teenage childbearing cost the nation $16.6 billion last year. The problem is monumental among black teens (more than half of black children are now born to teenagers) and foreshadows large-scale social failures for this group through the coming decades. Even considering only white Americans, the United States leads industrialized nations in teenage births and abortions. American teens, however, are not more sexually active than those in other Western nations: "Overall . the lowest rates of teen-age pregnancy were in countries that had liberal attitudes toward sex [and] had easily accessible contraceptive services for young people, with contraceptives being offered free or at low cost and without parental notification."
How is it that we have outdone all other nations in warning expectant mothers about the dangers of drugs and alcohol, and yet we have increasing infant mortality and birth defects? The French do not incessantly warn pregnant women never to drink. Why, then, are their birth outcomes so much better than ours, even given their lower per-capita income and investment in medical technology? We might ask the same question about why we have done so poorly at discouraging teen pregnancies, even while we spend so much more than other nations on efforts to discourage adolescent sexual activity. To analyze our failure to protect newborns from death and deformity, despite gargantuan and expensive medical and public health efforts, is to recapitulate the themes in this book. We fail because:
1. Disease diagnoses of problems shift the emphasis from social and cultural to individual causes and cures.
Many of the problems of newborn mortality and defect are localized in the underclassthe mostly minority, ghettoized segments of our society that are immune to all our best warnings and whose lives point them toward drug and alcohol abuse and toward other unhealthy behaviorsparticularly during pregnancy and early childhood-that undermine infant, child, and adult health. The underclass is a problem we have been absolutely unable to affect. Indeed, the worsening teen pregnancy problem, particularly in ghettos, guarantees a larger core underclass and even poorer birthing outcomes for the future.
2. We substitute moralizing for meaningful interventions.
While Nancy Reagan and others implore teens not to have sex or take drugs or drink, we do nothing to reverse the social conditions associated with these behaviors. Furthermore, the evidence is that those who are already more conflicted about their sexual activity are more likely to have unwanted pregnancies. "Unmarried women with negative attitudes toward sex tend to use less reliable methods of birth controlif they use them at all.. Women with such negative attitudes seem to have trouble processing information about sex and contraception and often rely on their partner to make decisions about contraception."
3. While we fail to inform (at least in a way they can use) the least informed, we at the same time alarm the most alarmist and misinform everybody.
Those who most require advice about drinking"women who drink heavily and whose children are at greatest riskare the least responsive to this type of [informational] campaign. Yet many women are in a constant state of anxiety about the impact of their behavior on their unborn infants, "constrained by a multitude of prohibitions that may overwhelm" them. These women are often severely distressed, with negative results for their own health and that of their fetus. They are the callers to fetal alcohol hotlines, hysterical because they ate rum cake unwittingly at a party. As Rosett and Weiner point out, "exaggerating the facts about alcohol and pregnancy blurs the real dangers of heavy drinking. It distracts . public health efforts from the target population in greatest need."
4. We miss the life-style for the trees.
Women don't maim their unborn children because they are unaware of the dangers of alcohol, just as mothers who abuse drugs are hardly under the impression this could be good for a fetus: "Despite women's awareness of the potential dangers of alcohol use during pregnancy, . 20% reported consumption at levels that they themselves defined as 'risk.'" Nor do these women overdrink primarily because they are "alcoholics" who cannot control their drinking. They actually are expressing a worldview, a style of life, that goes beyond individual health warnings and treatment of one type of substance abuse or another. For example, heavy drinking is inextricably related to cigarette smoking and other drug use in the populations most likely to damage their unborn children. These women already receive too many health warnings relative to their capacity to assimilate this information and to translate it into realistic coping and improved health and living conditions.
But Even the Privileged Are Not Well Off
The failure of the United States to match the safety record of other industrialized nations in birthing and neonatal care extends beyond the poor and underprivileged, however. For the United States is distinctive not only for its uneven distribution of prenatal care and thus the high infant mortality and disability rates among ghettoized and impoverished mothers. The broad middle class of America is oddly ambivalent and anxious about childbirth. We saw, for example, that many middle-class mothers express tremendous fear about their prenatal behavior, including having unwittingly drunk barely detectable amounts of alcohol. Yet Rosett and Weiner indicate that the "stress from preoccupation with possible dangers [to the fetus] may be a greater danger than any of the activities [the mother fears] themselves. "
This fearfulness about childbirth and pregnancy seems odd in a nation with the greatest reliance on medical care in the history of the world. Americans have highly technological births. As a rule, even healthy and low-risk births occur in hospitals, under medication, with the mother hooked up to a fetal monitor, and with a high percentage of cesareans. Yet birth outcomes are worse in the United States than in any other Western society, even among economically better-off Americans. For example, the U.S. cesarean rate is double to triple that of every European country with an infant mortality rate lower than that of the United States. Europeans simply don't demand the degree of medical attention to deliver babies that Americans do: every country in Europe with lower perinatal and infant mortality rates than the United States uses midwives as the principal birth attendant for at least 70 percent of births.
The contrast is perhaps greatest between Hollanda country in which 5 percent of births are by cesarean sectionand the United Statesin which almost a quarter (24.4 percent) of births were cesarean in 1987. Moreover, in Holland, 36 percent of babies are born at home, and most deliveries even on hospital premises are in nonmedical settings in which mothers are attended by midwives and leave after a maximum thirty-six hour stay. Nonetheless (or perhaps as a result), Holland has fewer infant deaths than the United States even when minority women are factored out. Underlying these differences in approach to and outcomes from birthing is an attitudinal difference between Americans and the Dutch. Dutch society anticipates that birthing will be difficult and will involve some pain, but women accept this as a normal part of giving birth.
All this leads to notable differences in the birthing landscapes of the two countries. American women often report anxiety about the aggravation and strain of undergoing vaginal births. While many middle-class Americans enroll in birthing classes to assist them in giving birth naturally (which few manage to do), the Dutch, with far less fanfare, almost uniformly have medically unassisted births with better outcomes. This fact recapitulates the theme of this bookthat despite our preoccupation with health and with being psychically liberated, we are increasingly dependent on external agencies and less sure of our ability to manage our own bodies and our lives. Something in our social milieu defeats educational programs purported to encourage parents to be more self-reliant in giving birth, as this goal is constantly undercut by medical advertising claiming advances that make childbirth safer and more comfortable.
How Dangerous Is Our Children's World?
Anxieties about childbirth are matched by anxieties about raising children in what we see as a very dangerous world. Is the world really a more dangerous place for children today than it was twenty or fifty or one hundred years ago? Children are more likely to be exposed to drugs, although most take drugs only casually and outgrow their drug use. Some groups of adolescents have always drunksome heavilybut drinking is more widespread among the young than in previous decades. Young people are also sexually active at earlier agesalthough since few adolescents get AIDS from heterosexual contact, the most life-disrupting danger from teen sex is premature parenthood. Murder by and against children has risen in recent years, particularly in the inner cities. Suicide is also reported at a higher level, although some argue that this number has not substantially increased for adolescents. All told, accidents, suicide, and murder constitute the three major causes of death among young people. On the other hand, children in the last century certainly died more frequently from illness, as well as from accidents and violent causes overall.
It is not clear that some epidemics from which children are said to be sufferingsuch as child abuseare at especially high levels today. For most periods in the history of the world, children did not enjoy a special place of regard, and the young were likely to suffer abuse and neglect of all kinds. More recently, in the United States, it seems unlikely that most people hit their children more than did their own parentscorporal punishment, once a common feature of middle-class homes and schools, has apparently diminished greatly. Covering a more recent period, Murray Straus and his colleagues found in their national surveys that the number of parents who reported violence toward their children declined by almost half between 1975 and 1985, from 3.6 percent (36 in a thousand) to 1.9 percent. (Wife abuse also declined in this period, from 3.8 percent to 3.0 percent.) Once again the increases in reported deaths of children from neglect and abuse in the last decade are mainly localized in inner cities.
While some question the Straus group's survey results because they don't believe parents would honestly report abusing their children, it isn't clear why fewer parents would admit abusing their children in one survey compared with another if there were no differences in actual abuse. The researchers think the most likely cause for this declinesince family violence is highly associated with economic downturns and povertyis that 1985 was a much better year for Americans economically than was 1975. It is also possible that the last ten years have made Americans less approving of family abuse and that this has translated into less abuse.
Although family abuse may be overstated, abuse by parents still far and away constitutes the most abuse against children. When combining the major causes of danger to the youngaccidents, suicide, murder, drugs and alcohol, and physical and sexual abusewe must always remember that the major sources of such harm are the young themselves, their friends and acquaintances, and their parents. It remains a truism of the study of murder, for example, that most killers know their victims, and that a large percentage of victims and killers are relatives or lovers. The Child Welfare League of America, reporting on child sexual abuse, similarly makes clear that such victims are generally abused at home by their parents. While we look outside with fear and dread, the dangers within ourselves and our homes are by far the greatest threats to our health and happiness.
Why do we often prefer to conceptualize our fears as external dangers or dangers beyond our control? This is how we often think about drug abuse, and this approach underlies the entire addiction treatment movement. One example of this externalization in the case of abuse of children is the ubiquitous fear in our society that children's Halloween candy is being poisoned or booby-trapped. Halloween is the occasion for nonstop media warnings about examining minutely every piece of candy the kids bring home (if we let them out at all). Examining "the widespread belief that anonymous sadists give children dangerous treats on Halloween," researchers Joel Best and Gerald Horiuchi examined seventy-six specific incidents reported in the quarter-century between 1958 and 1984. They found no deaths or serious injuries caused by sadists in any of these stories.
Best and Horiuchi did find that two highly publicized reports of deaths that were said to be caused by Halloween treats were in fact cases of abuse closer to home. In 1970, five-year-old Kevin Toston died after eating heroin that he reportedly found in his candy. But investigation revealed that the boy found the heroin he ate in his uncle's house. An even more notorious death was that of eight-year-old Timothy O'Bryan, who died in 1974 after eating a cyanide-laced treat. However, police later found that the boy's father had poisoned the candy. In other stories, children placed a dangerous object in the treat because they wanted to play a prank and had heard so many news warnings about contaminated candy. For the researchers, "Halloween sadism can be viewed as an urban legend, which emerged during the early 1970s to give expression to growing fears about the safety of children, the danger of crime, and other sources of social strain."
Also common among parents is the fear that small children will be kidnapped and/or assaulted by a stranger. Indeed, one version of this fear has organized gangs canvassing shopping centers for unattached children, whom they then spirit off. This, too, appears to be an urban legend. The American Academy of Pediatrics reviewed the status of missing children in the United States, with special reference to kidnappings by strangers. Of all missing children, 95 percent are runaways, while the vast majority of the rest are kidnapped by a parent, usually in a custodial battle. "In 1984," the academy reported, "the Federal Bureau of Investigation had nearly 350,000 reported cases of missing children, but only 67 of these missing children were kidnapped by strangers." Other experts outside the FBI say there may be more children abducted by a stranger than the FBI investigates in a given year. Nonetheless, according to Gelles and Straus, there are perhaps a thousand kidnappings of children by parents for every kidnapping by a stranger. 
The relatively small number of children who are kidnapped by strangers are not usually picked up at shopping malls or in front of their homes while playing. One of the sixty-seven children on FBI records in 1984 was Inez Jean Sanders. Inez was abducted at age five when her mother left her with a woman the mother had befriended in a motel in Phoenix, Arizona, while the mother was traveling alone to her parents' home in Florida for ten days in 1980. The kidnapper later abandoned Inez, and five years after the abduction the girl was reunited with her mother. In other words, these kidnappings are frequently associated with high-risksometimes extremely high-riskbehavior by a parent. Compare this reality with the warning issued to parents on television and in newspapers by Daniel Travanti about kidnapping: "It can be anybody. You can never tell."
Travanti is used in advertisements for missing children because he played John Walsh, the father of Adam Walsha six-year-old boy who was kidnapped at a shopping mall in 1981 and murdered by his abductor. This story, made into a TV film in 1983, has had a tremendous impact on American society. The original film described the incredible anxiety and then the pain that Adam's parents experienced, along with the absence of a system for finding a lost child (although Adam in all likelihood would not have been helped by such a system). The Walshes' and Adam's story eventually played a key role in the passage of the Federal Missing Children Act in 1982 and the establishment of the National Center for Missing and Exploited Children.
Material accompanying the Adam film claimed that fifty thousand parents would never see their lost children again, creating the impression among many that fifty thousand children had been kidnapped (and perhaps killed) by strangers. In addition, the National Center estimates that between 1. 3 million and 1. 8 million children are missing. These alarming statistics have been explicitly challenged by the FBI. A news story on NBC's Nightly News (the network that showed Adam) in 1985 reported the FBI claims that between twenty thousand and fifty thousand children had been missing for a "significant" time. Of all children ever reported missing, 95 percent are discovered within twenty-four hours and many of the rest shortly thereafter. Since most of the long-term missing are runaways and most of the rest are kidnapped by a noncustodial parent, the program concluded that the probability of a child's being abducted by a stranger is the same as that of being struck by lightning.
But who would object to statistics that make parents, children, and schools more careful in guarding against abduction? In other words, so what if these programs and national centers are alarmist? The contrary position is that, at this point, many people are already intensely worried about the danger of kidnapping. The NBC program interviewed a girl in an Illinois school who thought that "kids were being kidnapped every day" in the neighborhood. In fact, the program reported, no child in the school district had ever been kidnapped. Some very prominent spokespeople oppose the national campaign to fingerprint school children, as one expression of our hysteria over kidnapped children. Dr. Spock, for one, claims that such programs give children morbid fears that are unwarranted, fears that the programs do nothing to reduce.
Overall, we have two contrasting views of the dangers children face. One is expressed by Richard Schoenberger, head of the juvenile section of the Michigan State Police: "We found that the chances of a stranger abducting a child were so minimal [less than I percent of missing children in a study conducted by his department], parents should not be tethering their children to the front yard." John Walsh, on the other hand, has declared, "No town is safeno child is safefrom the sick, sadistic molesters and killers who roam our country at random. This country is littered with mutilated, raped, strangled little children." John Walsh's suffering tells him this is the case. Whether or not our society should act as though this were the caseand the consequences of living by this worldviewmay be a different matter.
Whatever the objective dangers of kidnapping today are compared with these of previous eras, children's lives today are unquestionably more circumscribed than they were in the past. Manyif not mostparents consider it unfeasible for children, even teenagers, to take a bus into the city or ride a bike into town on their own. What is lost because of this caution is the idea that children can learn and grow from exploration, independence, and even a degree of risk and adventure. Yet the abilities to manage oneself, to accept the responsibility of independence, and to generate adventure and excitement without behaving antisocially are skills that enable people to avoid drug or alcohol abuse and other addictions. Consider, for example, that today the term latch-key kids describes a new social ill. On the other hand, having responsibility for keeping house, watching smaller children, and filling one's time constructively was a common requirement for most farm or immigrant children, many of whom benefited in maturity and self-control from these experiences.
How Fear of Our Communities Causes Our Problems
Although a director of the National Center agrees that the number of lost children identified through fingerprinting is "pretty minuscule," he nonetheless maintains that the program is essential for "focusing parental concern on the danger of abduction." However, scare programs for drugs and crimeas in the case of the lifer's program depicted in the film Scared Straight (see chapter 5)have shown more negative results than benefits. According to the chief of the prevention research branch of the National Institute on Drug Abuse (NIDA), "Those programs that use scare tactics, moralizing and information alone may actually have put children at increased risk"that is, they result in more drug use. It is worth noting that this description applies not only to David Toma's bombastic moralizing but also to the full-page ads that the NIDA itself sponsors under the aegis of the Partnership for a Drug-Free America, like the one of the father mourning in a graveyard because he missed the signs that his child was using drugs.
In the case of prophylactic campaigns about kidnapping and Halloween candy, what suffers most is our feeling of community. These campaigns-and the spirit underlying themdirectly attack community life. And every problem identified in this book is exacerbated by, the diminution of our communities. Even stranger kidnappings are best combated by community efforts. For example, years after schoolboy Etan Patz disappeared on the way to his bus in New York City, a cab driver revealed that he had driven the apparently protesting boy and a man to the train station. The feeling of involvement that would make observers step in under such circumstances is the best guarantee that children will be protected.
Let us return to the Lisa Steinberg case, described in chapter 8. In dealing with family abuse, simply catching and remonstrating with an abusive parent or husband has approximately the same impact as does therapy for abuse, and a significant number of husbands stop beating their wives or children when they are singled out by the community, friends, or the police for their misbehavior. Recall also that Lisa's adoptive mother, Hedda Nussbaum, isolated herself from her family, her job, and her friends as her lover Joel Steinberg's beatings became more severe. With fewer outside people entering their home to notice and comment on Nussbaum's appearance and the strange goings-on in the Steinberg household (such as the filth and disruption), there were no checks on Joel Steinberg's increasingly bizarre behavior.
Having faith that the world is a place amenable to our control and that other people are well-meaning and can be befriended is an essential component of mental health and normal human development. To lose the sense that the world is a good place is to lose something irreplaceablea loss no amount of therapy can assuage. The violent relationships we examined in the previous chapter are related to this pervasive alienation from people and the environment. Those who are most suspicious of the world around them and unable to be comfortable with other people are those most desperate to latch onto another personoften a completely inappropriate partner or a relationship doomed from its onset to selfdestruct. In my book Love and Addiction, I showed that the love addict is not someone with the most experience at intimacy; rather, it is the withdrawn and alienated who are most susceptible to forming treacherous, explosive, and selfdefeating ties with other peopleincluding their lovers.
DENYING WHAT GOES ON IN THE HOME
A major point made by the children of alcoholics movement is that the family is forced to deny the abnormality of the drunken parent's actions, thus creating a kind of insane inner family life. The same holds for violent families. We may wonder whether the same kind of denial and insanity holds for families of compulsive eaters, gamblers, shoppers, PMS and depression sufferers, and so on. And what about highly neurotic parents who shout a great deal? Is their behavior accepted as par for the course within the home and denied and hidden from outsiders? For many families, family problems (and denial and insanity) are introduced by the childrenfor example, when they take drugs. If the mathematics add up to every American having at least one disease, then every family is undergoing some form of denial.
Is the solution, then, to get all these families into treatment along with the diseased member? When the middle-class families whose children abuse drugs and who then join parent support groups finally let down their guards in public to describe their problems, they often for the first time share their fears and anxieties with other families. But being open and sharing feelings could well have improved their family problems long before this point, as they would for practically every family in America. The point is not to organize a group for every variety of family problem; the point is that nearly every American home would be improved by greater contact with other families, by greater community support, by greater intimacy with nonfamily members. This is because, first, families behave better when they are in contact with outsiders. Second, children would have a broader variety of models of family behaviorsometimes better, sometimes worseto choose from. And third, Americanslike all peopleneed more emotional support than they are able to get within their immediate families alone.
We saw early in this chapter that obesity is an addictive behavior and a health problem that is growing rapidly among children, and that a definitive link has been established between television viewing and obesity. What is it about the act of watching television that increases the risk of addiction, as in the case of obesity? Kids get fatter watching television because it is a sedentary activity that interferes with calorie-burning activities like playing outside. TV viewing also encourages addiction because it is a passive, consumer-oriented form of entertainment. Indeed, just as excessive eating is a passive form of entertainment built around consumption, so too are excessive drug taking and drinking. The link between watching television and obesity and other addictions is that watching television depletes the child's resources for direct experience and interaction with the environment in favor of vicarious experiences and involvements.
One reason drug addicts and alcoholics welcome their addictions is because they perceive these to be safer than the riskier activities of putting themselves on the line in dealing with the world free of drugs and alcohol. Thusparadoxicallyyoung drug abusers and drinkers may be more fearful than their non-substance-abusing counterparts, even though they actually court more danger and get into more trouble. There is evidence that people who watch more television are more fearful than others. Research by George Gerbner, dean of the Annenberg School of Communications of the University of Pennsylvania, has shown that heavy television viewers overestimate the number of crimes and other dangers in their environments.
In part, the explanation for the association of fear and television viewing is that children who are more fearful in the first place stay in to watch television more. At the same time, Gerbner hypothesizes, television focuses so much on crime that it convinces viewers that the world is a dangerous place. Thus, regardless of whether the world has become more dangerous in the last quarter-century, television viewing has made it seem that way. Many of our messages to children accomplish the same thing, and it would seem that we have more frightened children today. However, as the example of TV and overeating indicates, our fear-inspiring communications rarely lead to better health or other positive results. Instead of frightening children, what we must actually do to combat obesity and other addictions is to make our children less afraid and more capable of facing their environments, even though these can never be made fully secure and certain.
One test, then, of whether our society can combat drugs and drinking and dangerous love relationships is whether we can make people, especially children, less rather than more fearful. This formidable task is one on which we seem to be losing ground rather than making progress, as we constantly strive to make children more afraid of drugs, as well as a number of other activities. In the United States today, we have given up on the idea that childrenand adultscan be counted on to make decisions on their own about drugs, and instead we dedicate ourselves to an escalating war to eliminate all exposure to drugs. If our goal were to create people competent to deal with their environments and content enough to resist self-destructive temptations, our current efforts would prove we had already lost the war on drugs. If, on the other hand, children welcomed life enough to resist addiction on their own, drug abuse in itself would become a minor problem.
The disease theory of alcoholism and addiction is an elaborate defense mechanism to prevent us from examining those things thatindividually and as a societywe fear too much and do not believe we can deal with. One of people's primary purposes in taking drugs and drinking excessively is to eliminate the fears with which they cannot deal realistically. As a society, the fantasy that abusing alcohol and drugs is the result of a disease rather than of misdirected human desire and faulty coping skills is also meant to reassure us. Yet just as with the individual alcoholic or addict, relying on this reassuring fantasy debilitates us for combating the problems from which we recoil. Put simply, we don't have the courage to confront the dilemma that addiction is transmitted through ordinary family and societal processes, including such daily socially sanctioned activities as television viewing and our fearful messages about the outside world. We will never begin to combat addiction effectively until we can examine ourselves and our society and find the sources of addiction within.
Summary: Loss of Control as a National Theme
In this chapter, I have explained that we have been unable to improve the health of the newborn, despite having the most technologized health care system in the world. I have also discussed how our concerns about the health and safety of our children have become irrational, as have our fears about strangers and about our communities. I have analyzed how our fears stem primarily from our sense of being unable to control our worlds as individuals, as families, and as communities. But what has given us the idea that we are so impotent and helpless? Why have we become enmeshed in dysfunctional, exaggerated fears about our environment? Why have we decided that weand our childrencannot control even our own emotions and behavior?
Why is it that America has now entered the age of addiction? Why have we become so afraid that addiction is everywhere and that we are out of control of our eating, shopping, lovemaking, gambling, smoking, drug taking, menstrual cramps, feelings after birth, anxieties and depressions, and moods of all kinds? What characterizes modern-day Americans and American society that can possibly explain the out-of-control growth of the experience of being out of control? Let me list what I believe to be the main dimensions of this problem:
1. We have marketed loss-of-control conceptions to a fare-thee-well.
We so often believe we have lost control because we are told so constantly about the danger that we will lose control, about the prevalence of loss of control, and about the signs that indicate we have lost control. It is only to be expected that so many people would take up the cues from the media and everywhere else around them that maybe they, too, are out of control of something in their lives, and that this is a disease requiring a kind of medical attention. It is also a natural by-product of the marketing of loss-of-control ideas and treatments that we increasingly see the world as an uncontrollable place.
2. We are alienated from many of our basic emotional and physical experiences.
Among technological societies, we in the United States are the most alienated from basic emotional and physical experiences. In our efforts to protect ourselves from accident and assault, we have built up our fears of our physical and social environment to the point that dealing with our fearfulness is frequently our most pressing problem. As a result, we worry incessantly that no matter how sensibly we act, we can be hurt by the world around us, by the people around us, and by our own bodies and behavior.
3. America is the most medicalized of all societies.
Americans rely more on medical technology for solutions to both sickness and ordinary life problems than any other society. Americans invariably seek more medical treatment, and American doctors and other professionals seek to provide this treatment, whereas Europeans more often allow healing to take its course and recognize that every medical intervention has its own risks. Indeed, Europeans more readily accept that every problem does not have a solution and that life has a good deal of uncertainty and imperfection about it. The American credo, in contrast, is that medicine can ultimately fix everything that is wrong with us. This reliance on medicine extends to our attacks on our largest, most complex social problems.
4. We are preoccupied with our innermost feelings but are oblivious to how these feelings stem from our sociial relationships.
Americans are famous for their self-improvement programs, particularly those geared toward emotional well-being. At times it seems that, as a nation, we are all involved in the constant contemplation of our neuroses. Yet although we spend so much mental energy examining what is wrong with us and our relationships, we refuse to consider how our emotional states and patterns of interacting are linked to social structures like family, work, and community. We prefer to make individual resolutions to change or to consult with private physicians or therapists or to join self-help groups rather than to strive to change our families, our work, and our communities.
5. Americans are not comfortable in communal arrangements.
One great paradox in America is that so many of us are willing to join self-help groups and movements, and yet are reluctant to be part of our own communities. Americans live and love isolated suburban existences. We don't meet in pubs, cafés, and boulevards like those in some countries, or join with neighbors or extended families in sharing meals and household space. In fact, "making it" means not having to do these things. As a result, for most Americans, the concept of community is moribund. The condo "community" of transients is the model for American life today.
6. Americans are ambivalent about alcohol, drugs, and intoxication.
From temperance to Prohibition to the modern drug era, an awful lot of American history has focused on efforts to regulate Americans' pursuit of intoxication. Why is this? Americans are both prudish and idealistic, so that we believe we can be perfect and that intoxication and bad behavior should and can be eliminated. At the same time, like people everywhere else, many Americans welcome intoxication. Only for Americans, our drive for intoxication conflicts so greatly with the value we place on self-control. It is, of course, our constant disappointment at failing to live up to this valuea value many cultures don't sharethat makes us so preoccupied with loss of control.
7. Temperance and AA have radically affected the American sensibility.
The historical facts of temperance, Prohibition, and AAwhile they spring from the depths of American culturehave also had a tremendous impact on how we conceptualize our social and personal problems. The mission of temperance adherents and AA proselytizers has been to convey the beliefs that alcoholism is a disease and that alcohol exercises an alluring but destructive power over our bodies and minds-our souls, in fact. And these preachers and businesspeople have done a passionately successful job in selling Americans this view of the world. One of the most successful aspects of this sales job has been the convincing of liberal-minded Americans that it is most humane and helpful to regard drunkenness and other misbehavior as being out of people's control.
8. Disease conceptions have come to stand for all of our fears.
We in America congratulate ourselves on discovering so many things that can addict us (a list that grows never-endingly), at the same time that we never gain a sense that we can control the sources of our fears. These two themes interact addictivelythat is, more of the one creates more of the other. In this addictive cycle, we feel temporarily relieved when we can claim some unwanted behavior (our own, our children's, a stranger's) is due to some new disease. But the longer-term consequence of this process is to make us more frightened and impotent and more likely to identify new diseases. Addiction then becomes the all-purpose explanation for the control of ourselves and our worlds that constantly eludes us.
- J. Best, "The myth of the Halloween sadist," Psychology Today, November 1985, 14-16. (back)
- John Noble, deputy director of biometry and epidemiology, National Institute on Alcohol Abuse and Alcoholism, quoted in M. Korcok, "Alcohol treatment industry to grow as risk group matures," U.S. Journal of Drug and Alcohol Dependence, March 1987, 1. (back)
- A. J. Stunkard et al., "An adoption study of human obesity," New England Journal of Medicine 314(1986):193-98. (back)
- B. D. Ayres, Jr., "Washington finds drug war is hardest at home," New York Times, 9 December 1988, A22. (back)
- A. J. Stunkard et al., "Influence of social class on obesity and thinness in children," Journal of the American Medical Association 221(1972):579-84. (back)
- F. E. Braddon et al., "Onset of obesity in a 36 year birth cohort study," British Medical Journal 293(1986):299-303; P. B. Goldblatt, M. E. Moore, and A. J. Stunkard, "Social factors in obesity," Journal of the American Medical Association 192(1965):1039-44. (back)
- S. L. Gortmaker et al., "Increasing pediatric obesity in the United States," American Journal of Diseases of Children 141(1987):535-40. (back)
- W. H. Dietz and S. L. Gortmaker, "Do we fatten our children at the television set?" Pediatrics 75(1985):807-12. (back)
- J. Katz, Seductions of Crime (Basic Books, 1988). (back)
- Winfred Overholser, chairman of the Executive Committee of the Research Council on Problems of Alcohol, cited in B. H. Johnson, The Alcohol Movement in America (Ph.D. diss., University of Illinois, 1973), 247. (back)
- Raymond McCarthyalthough Marty Mann objected to the use of the term drinking habit, she had no quarrel with McCarthy's numberscited in ibid. 293-95. (back)
- M. Mann, Marty Mann Answers Your Questions About Drinking and Alcoholism, rev. ed. (Holt, Rinehart and Winston, 1981), 3. (back)
- D. Cahalan, Understanding America's Drinking Problem Jossey-Bass, 1987), 6. (back)
- B. Weinraub, "Money Bush wants for drug war is less than sought by Congress," New York Times, 30 January 1989, 1, A14. (back)
- David Sheehan's book, The Anxiety Disease (Scribner, 1984), argues that anxiety is a medical condition that responds to drug treatment, although sufferers need to learn that anxiety is a lifetime disease that they can never escape; Mark Gold's book, The Good News About Depression (Villard, 1987), explains that, although depression is increasing (one out of four people will be struck by it), it can be treated medically with drug therapy. (back)
- J. Brody, "Personal health," New York Times, 15 January 1986, C6. Copyright 1986 by The New York Times Company. Reprinted with permission. (back)
- J. T. Wright et al., "Alcohol consumption, pregnancy, and low birth-weight," Lancet 1(1983):663-65. (back)
- R. Hingson et al., "Effects of maternal drinking and marijuana use on fetal growth and development," Pediatrics 70(1982):539-46. (back)
- H. L. Rosett and L. Weiner, Alcohol and the Fetus (Oxford University Press, 1984). (back)
- M. Wagner, testimony before the U.S. Commission to Prevent Infant Mortality (International Comparisons Section), United Nations, New York, 1 February 1988. (back)
- R. D. Lyons, "Physical and mental disabilities in newborns doubled in 25 years," New York Times, 18 July 1983, 1, A10. (back)
- N. Brozan, "U.S. leads industrialized nations in teen-age births and abortions," New York Times, 13 March 1985, 1, C7. (back)
- C. Turkington, "Contraceptives: Why all women don't use them," APA Monitor (American Psychological Association), August 1986, 11. (back)
- Rosett and Weiner, Alcohol, 17 1. (back)
- Wagner, testimony. (back)
- C. A. Miller, Maternal Health and Infant Survival (National Center for Clinical Infant Programs, 1987). (back)
- "Hospital says rules reduced cesarean rate," New York Times, 8 December 1988, B26. (back)
- R. J. Gelles and M. A. Straus, Intimate Violence (Simon and Schuster, 1988). (back)
- J. Best and G. T. Horiuchi, "The razor blade in the apple: The social construction of urban legends," Social Problems 32(1985):488-99. (back)
- American Academy of Pediatrics, "Missing children," Pediatrics 78(1986):370 72. (back)
- Gelles and Straus, Intimate Violence, 18. (back)
- "Five years after kidnapping, girl celebrates 10th birthday at home," New York Times, 18 February 1986, A20. (back)
- "Child ID efforts criticized," Daily Record (Morris County, N.J.), 7 November 1985, 1 (reprinted from Denver Post). (back)
- "Some school drug efforts faulted," New York Times, 17 September 1986, B1, B6. (back)
- G. Gerbner and L. Gross, "The scary world of TV's heavy viewer," Psychology Today, April 1976, 41-45. (back)
- L. Payer, Medicine and Culture (Holt, 1988). (back)