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Making a difference (presidential address)
J O U R N A L OF ADOLESCENT H E A L T H 1993;14:408-411
SOCIETY FOR ADOLESCENT MEDICINE
Making a Difference (Presidential Address) LONNIE K. ZELTZERI M.D.
During the past few weeks, I had the opportunity to watch my friend die from cancer. I say it was an "opportunity" because she and her family taught me more than they could imagine from sharing in this process with them. It was the impact of this experience that propelled me into a different view of what we, as a Society of individuals who care deeply for adolescents, can do NOW "to make a difference." First, I would like to tell you about the essence of this experience and then I will tell you about my view and plans for our Society. My friend, Rita, was the wife of a career Navy Captain. She raised three sons, often alone when her husband would spend six to nine months at sea. She was a "goodwill" ambassador for the United States when she lived in numerous countries after her husband became a member of the Diplomatic Corps. She carried this out with grace as she did what she needed to do to help her husband's career. After he retired from government service, the family settled in Los Angeles, where our families became friends. Three years ago she was diagnosed with ovarian cancer and went through multiple treatment regimens. However, during this process she began to review her life and become acquainted with herself. Roughly six weeks ago, Rita was hospitalized after her tumor had spread. Rather than having major surgery, she chose instead to go home and set the pace of her dying. She "took charge" of her dying process deciding when she would stop IV fluids and when she would die. What was most remarkable is
Presented March 21, 1993 at the Annual Meeting of the Society for Adolescent Medicine, Chicago, IL. Please send correspondence to: Lonnie K. Zeltzer, M.D. Professor of Pediatrics, Director, Pediatric Pain Program, UCLA School of Medicine, 10833 LeConte Avenue, Los Angeles, California 90024-1752, Phone: (310)825-0731, Fax: (310)825-5834. 408 1054-139X0/93/$6.00
how she used her dying and how her family gave her the support to do this. I watched Rita put her "life in order," saying the things she wanted to say to family and friends, giving away her possessions to individuals with explanations of why she selected each item for that particular person. I watched Rita, her family, and friends share humor in jokes and stories about themselves and others. Most impressively I watched her husband, sister, sons, and daughters-in-law take loving care of her physical and emotional needs, including care provided by her nine year old grandson, Nicky, who would climb into bed with Rita where they would have long discussions. When Rita finished saying all that she had to say and when she felt satisfied that her family and friends had the opportunity to say to her what they wished to say, she reported that she was ready to "go to sleep" and died. You may be wondering, "What does this story have to do with our Society?" Well, this experience impressed upon me the power that the ways of living and caring can transcend generations. It made me think about the type of mothering that this woman gave to her sons, especially during their adolescent years (and they were pretty wild adolescents) to enable them to become such caring and unselfish adults and to enable them to provide that type of parenting for their children. It re-emphasized for me the importance that significant adults have for adolescent development and self-value. I took a look at today's adolescents and realized that we, as a society-at-large, have failed them by focusing on ourselves and ignoring our community. Twelve years of Reagan and Bush have left us with fears for our own economic security, feelings of helplessness about our ability as individuals to create change, and a focus on self-protectiveness, with ap-
© Society for Adolescent Medicine, 1993 Published by Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
July 1993
athy regarding the impact of this degeneration of our society on our youth. One of my early mentors, Dr. George Comerci, had once said that adolescents were the "agents of change" in society. When a society had decayed significantly enough, it was youth who would call this to the attention of a nation. As examples, in our country we can remember the civil rights movement of the 1960's, the Viet Nam war demonstrations of the 1970's, and the "nothing" of the 1980's. We have had twelve years of economic recession and cutbacks in health care, education, and social services. We have had policies dictated by a strong administration-based moralism regarding "right and wrong" and naive approaches to enhancing the "Moral fiber" of our society, with Nancy Reagan's "just say no" campaign as one example. The impact of this approach, however, has been a lack of caring for our youth as they struggle to find meaning in life and to plan for their future. We, as a society, have, in effect, told our youth that we do not care about them. If a society devalues its adolescents, it is likely that its adolescents will devalue themselves. If parents have developed "learned helplessness" over the past twelve years, that is, the feeling that whatever they do will not matter, it is only logical that this feeling of helplessness will be even stronger in our youth. Teenagers who feel that no one really cares, see little opportunity for change, and feel thwarted in self-guided attempts at change, such as getting a job or being able to pay for college, will make decisions based on a short-term solution strategy. One example is the growing number of teens who actually choose to become pregnant because, as one 13 year old said, "Life is short. You never know when it will be over, so you have to play hard and fast." Feelings that "no one cares" or that parents (often single mothers) do not have "enough energy" left over for their children lead to desires in some adolescents to create someone "all their own, a baby who will love them and be theirs." Some male adolescents in the inner cities have said that they expect that they will likely not live past 19 years of age, especially since they have already witnessed the deaths of several friends. These adolescents may spawn several offspring in order to "leave behind a legacy of value." How else can they give meaning to their lives if they see no other options? If many of today's adolescents feel that no one cares about them, what can they do to receive love? How can they channel their frustrations into actions that provide themselves with a sense of self-value and self-esteem? Participating in a gang, as one ex-
MAKINGA DIFFERENCE
409
ample, can provide the adolescent with a sense of meaning in life, a sense of belonging, a sense of community. Are adolescents turning to gangs because they feel that there are no adults in their community who care about them? In the poorer neighborhoods of Los Angeles, there are more than twice as many adolescents who end up incarcerated as end up in college. Is the increase in violence among youth the result of pent up anger, frustration over what appears to be limited or no opportunities for creating a better life, and feelings that "no one really cares"? Adolescence is typically viewed as a time of "high energy" and feelings of omnipotence. What happens when these feelings and energy have no constructive outlet? The Los Angeles riots of 1991 are one such example. Why else would a 14 year old youth push a 72 year old woman out of a moving car while attempting to take it for a joyride, as happened recently in Los Angeles? Furthermore, violence is not just happening in our inner cities. Why would a group of honor students plan a school computer robbery and shoot and kill one of the group when they learned that he planned to expose them, as also happened recently in Los Angeles? Why should there be so many shootings in the classroom that high schools, even in affluent neighborhoods, have to develop methods of detecting guns on students entering the school? This almost random violence is not just happening in Los Angeles, although lately it might seem so! I believe that many adolescents are acting out their frustrations because society has abandoned them. They are hitting us in the face with this fact and we can no longer ignore them. They are forcing our society to change. The William T. Grant Foundation described, in their recent report, "The Forgotten Half" (1), the problems facing our youth as they transition into adulthood, especially minority youth. One might ask, "if we as a society have forgotten our adolescents, what has enabled some adolescents to succeed, despite mounting obstacles?" I will suggest that the reason that these adolescents succeeded and felt "good enough" about themselves to do so is related in large part to the impact of an adult in their lives who really cared, to whom they "mattered." Such an adult might have been a family member, a teacher, doctor, or someone else in their community. But that contact, even if it was relatively brief, was clearly significant enough to make those adolescents feel valued, important, and empowered to feel effective. Although already much publicized through a movie (2), the case of Jaime Escalante, a math teacher at Garfield high school in East Los Angeles, is one
410
ZELTZER
such illustration. His faith, caring, attention, and work with his students, mostly poor and Hispanic, allowed them to have enough faith in themselves to learn calculus and pass the Advanced Placement Calculus Exam. There are many other unsung heroes who have given of themselves to help many other adolescents to develop the courage and selfconviction to attain goals that they otherwise would never have imagined possible. Adolescents who feel this way not only put their best efforts forward to succeed for themselves; but they also often give back to the community to help others. During the past few years, SAM has made tremendous strides. We have taken giant steps in pushing adolescent health into the forefront of health care delivery on national and international levels. We have played a major advocacy role on behalf of our nation's youth in the changes that are unfolding with the new Clinton administration. In this regard, it is noteworthy that our immediate past-president, Dr. Karen Hein, will spend this coming year in Washington as a public policy fellow advocating for youth. I would like to propose, as your incoming President, that we enhance our power as a Society to empower our adolescents, to let them know that "some one cares," that they "matter." I propose that, in order to accomplish this goal, we must do more than research, teaching, clinical service, and advocacy at a national level. We must act as individual SAM members to take a greater role in advocating for youth at a local level in our communities and in mentoring, interacting with adolescents on a one-on-one basis, both within and outside of our traditional professional roles. Each significant contact with an adolescent can be meaningful and hold potential for influencing that life. Often we believe that, in order to be effective, we have to make a contribution on a grand scale, such as heading a Division of Adolescent Medicine, publishing research, getting grants, or creating policy. I contend that the real impact comes in how we contribute to the well-being of the adolescents whom we see as part of our professional lives, those with whom we are involved with through our schools and community activities, and our own children and their friends. I propose two methods for accessing the talent of our membership to accomplish the goal of SAM "making a difference" on behalf of adolescents. The first is that you, as members, individually or through your regional chapters, write to me (addressed to the SAM office) describing what you did to "make a difference". This might relate to voluntary activities
JOURNALOF ADOLESCENTHEALTHVol. 14, No. 5
that you initiated at a school, a program that you set up in your community, or even something that you did with an individual adolescent in which you felt that your involvement "made a difference." I know that you are probably thinking that "Zeltzer is crazy because we make a difference every time that we take care of adolescents through our professional activities." However, there are likely many case examples, programs, voluntary activities known only to individual members. Overcoming obstacles to setting up an afterschool weekly "rap session" program or training teens in peer counseling might be new to one person but not to another. We can use the expertise of our membership to learn from one another for the betterment of the youth of our communities or, preferably more broadly defined, of "our cities." These descriptions often do not find their way into publication unless they emanate from research. While I am certainly not devaluing the importance of such research, I am suggesting that there is another type of critical information that is not typically "publishable" in the traditional sense, so that no one else has the opportunity to learn from these types of experiences and potentially benefit. I am recommending another forum for this material as a trial for one year. I am asking you for your help in describing novel approaches to empower adolescents. What did you do that "made a difference?" I will read each and every letter sent to me and will select, with the help of Dr. LeBaron, our Director of Publications, examples to publish in each SAM newsletter, with our editor Dr. McCabe's help. However, all letters will be saved and compiled into a booklet which we will have on file at the SAM central office. I will also work diligently with publishers to find a way to publish this book, "Making a Difference," so that many can benefit from its contents. The second proposal relates to the fact that SAM's administrative arm will be holding a retreat soon to plan for the direction of SAM activities and focus over the next five years. As your President, I would ask each of you to contribute to the direction of SAM by sending your suggestions and recommendations in writing to me addressed to the SAM office during the next four months. In particular, I would be interested in your thoughts about how we, as a Society, can help empower our membership to be local advocates for adolescents. H o w can we, a Society without much money, use our "people power" and networking abilities and already published written materials to facilitate this effort? This a goal that I believe we can accomplish by strengthening our re-
July 1993
gional chapters and formalizing the relationship between the chapters and SAM. I believe that by giving a greater voice to each individual member of SAM, to our regional chapters, and to our international members and friends, we can better serve as a facilitator for empowering our youth. We are, after all, a large and growing interdisciplinary organization. I would ask each of you to take this year as an opportunity to see what you can do at a local level to "make a difference." If we, SAM, use our collective talents, motivation, and passion for adolescents, we have the ability to make a major contribution to changing our country and lifting it out of its decaying foundations. Finally, but equally important, I also propose that we develop a method for giving a greater voice to adolescents in SAM itself to help guide our directions as a Society advocating for youth. I propose that we consider an adolescent membership in SAM,
MAKING A DIFFERENCE
411
with an adolescent advisory board on our program committee and an adolescent editorial board responsible for an adolescent section of our newsletter. The adolescent involvement in SAM might begin with and be structured through our regional chapters. Thank you all for having the faith in me to elect me as your President. I will offer you my passion for adolescents and my ear so that your voice can help to guide the future directions of SAM. I wish to thank Captain Jack Scapa and family for allowing me to share their time with Rita and for helping to guide the directions of the Society for Adolescent Medicine. This address is dedicated to them and to the courage and love of Rita Scapa.
References 1. The Forgotten Half, November 1988, The William T. Grant Foundation Commission on Work, Family and Citizenship. 2. "Stand and Deliver", starring Edward James Olmos, 1988, Warner Brothers.
SOCIETY FOR ADOLESCENT MEDICINE
Making a Difference (Presidential Address) LONNIE K. ZELTZERI M.D.
During the past few weeks, I had the opportunity to watch my friend die from cancer. I say it was an "opportunity" because she and her family taught me more than they could imagine from sharing in this process with them. It was the impact of this experience that propelled me into a different view of what we, as a Society of individuals who care deeply for adolescents, can do NOW "to make a difference." First, I would like to tell you about the essence of this experience and then I will tell you about my view and plans for our Society. My friend, Rita, was the wife of a career Navy Captain. She raised three sons, often alone when her husband would spend six to nine months at sea. She was a "goodwill" ambassador for the United States when she lived in numerous countries after her husband became a member of the Diplomatic Corps. She carried this out with grace as she did what she needed to do to help her husband's career. After he retired from government service, the family settled in Los Angeles, where our families became friends. Three years ago she was diagnosed with ovarian cancer and went through multiple treatment regimens. However, during this process she began to review her life and become acquainted with herself. Roughly six weeks ago, Rita was hospitalized after her tumor had spread. Rather than having major surgery, she chose instead to go home and set the pace of her dying. She "took charge" of her dying process deciding when she would stop IV fluids and when she would die. What was most remarkable is
Presented March 21, 1993 at the Annual Meeting of the Society for Adolescent Medicine, Chicago, IL. Please send correspondence to: Lonnie K. Zeltzer, M.D. Professor of Pediatrics, Director, Pediatric Pain Program, UCLA School of Medicine, 10833 LeConte Avenue, Los Angeles, California 90024-1752, Phone: (310)825-0731, Fax: (310)825-5834. 408 1054-139X0/93/$6.00
how she used her dying and how her family gave her the support to do this. I watched Rita put her "life in order," saying the things she wanted to say to family and friends, giving away her possessions to individuals with explanations of why she selected each item for that particular person. I watched Rita, her family, and friends share humor in jokes and stories about themselves and others. Most impressively I watched her husband, sister, sons, and daughters-in-law take loving care of her physical and emotional needs, including care provided by her nine year old grandson, Nicky, who would climb into bed with Rita where they would have long discussions. When Rita finished saying all that she had to say and when she felt satisfied that her family and friends had the opportunity to say to her what they wished to say, she reported that she was ready to "go to sleep" and died. You may be wondering, "What does this story have to do with our Society?" Well, this experience impressed upon me the power that the ways of living and caring can transcend generations. It made me think about the type of mothering that this woman gave to her sons, especially during their adolescent years (and they were pretty wild adolescents) to enable them to become such caring and unselfish adults and to enable them to provide that type of parenting for their children. It re-emphasized for me the importance that significant adults have for adolescent development and self-value. I took a look at today's adolescents and realized that we, as a society-at-large, have failed them by focusing on ourselves and ignoring our community. Twelve years of Reagan and Bush have left us with fears for our own economic security, feelings of helplessness about our ability as individuals to create change, and a focus on self-protectiveness, with ap-
© Society for Adolescent Medicine, 1993 Published by Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
July 1993
athy regarding the impact of this degeneration of our society on our youth. One of my early mentors, Dr. George Comerci, had once said that adolescents were the "agents of change" in society. When a society had decayed significantly enough, it was youth who would call this to the attention of a nation. As examples, in our country we can remember the civil rights movement of the 1960's, the Viet Nam war demonstrations of the 1970's, and the "nothing" of the 1980's. We have had twelve years of economic recession and cutbacks in health care, education, and social services. We have had policies dictated by a strong administration-based moralism regarding "right and wrong" and naive approaches to enhancing the "Moral fiber" of our society, with Nancy Reagan's "just say no" campaign as one example. The impact of this approach, however, has been a lack of caring for our youth as they struggle to find meaning in life and to plan for their future. We, as a society, have, in effect, told our youth that we do not care about them. If a society devalues its adolescents, it is likely that its adolescents will devalue themselves. If parents have developed "learned helplessness" over the past twelve years, that is, the feeling that whatever they do will not matter, it is only logical that this feeling of helplessness will be even stronger in our youth. Teenagers who feel that no one really cares, see little opportunity for change, and feel thwarted in self-guided attempts at change, such as getting a job or being able to pay for college, will make decisions based on a short-term solution strategy. One example is the growing number of teens who actually choose to become pregnant because, as one 13 year old said, "Life is short. You never know when it will be over, so you have to play hard and fast." Feelings that "no one cares" or that parents (often single mothers) do not have "enough energy" left over for their children lead to desires in some adolescents to create someone "all their own, a baby who will love them and be theirs." Some male adolescents in the inner cities have said that they expect that they will likely not live past 19 years of age, especially since they have already witnessed the deaths of several friends. These adolescents may spawn several offspring in order to "leave behind a legacy of value." How else can they give meaning to their lives if they see no other options? If many of today's adolescents feel that no one cares about them, what can they do to receive love? How can they channel their frustrations into actions that provide themselves with a sense of self-value and self-esteem? Participating in a gang, as one ex-
MAKINGA DIFFERENCE
409
ample, can provide the adolescent with a sense of meaning in life, a sense of belonging, a sense of community. Are adolescents turning to gangs because they feel that there are no adults in their community who care about them? In the poorer neighborhoods of Los Angeles, there are more than twice as many adolescents who end up incarcerated as end up in college. Is the increase in violence among youth the result of pent up anger, frustration over what appears to be limited or no opportunities for creating a better life, and feelings that "no one really cares"? Adolescence is typically viewed as a time of "high energy" and feelings of omnipotence. What happens when these feelings and energy have no constructive outlet? The Los Angeles riots of 1991 are one such example. Why else would a 14 year old youth push a 72 year old woman out of a moving car while attempting to take it for a joyride, as happened recently in Los Angeles? Furthermore, violence is not just happening in our inner cities. Why would a group of honor students plan a school computer robbery and shoot and kill one of the group when they learned that he planned to expose them, as also happened recently in Los Angeles? Why should there be so many shootings in the classroom that high schools, even in affluent neighborhoods, have to develop methods of detecting guns on students entering the school? This almost random violence is not just happening in Los Angeles, although lately it might seem so! I believe that many adolescents are acting out their frustrations because society has abandoned them. They are hitting us in the face with this fact and we can no longer ignore them. They are forcing our society to change. The William T. Grant Foundation described, in their recent report, "The Forgotten Half" (1), the problems facing our youth as they transition into adulthood, especially minority youth. One might ask, "if we as a society have forgotten our adolescents, what has enabled some adolescents to succeed, despite mounting obstacles?" I will suggest that the reason that these adolescents succeeded and felt "good enough" about themselves to do so is related in large part to the impact of an adult in their lives who really cared, to whom they "mattered." Such an adult might have been a family member, a teacher, doctor, or someone else in their community. But that contact, even if it was relatively brief, was clearly significant enough to make those adolescents feel valued, important, and empowered to feel effective. Although already much publicized through a movie (2), the case of Jaime Escalante, a math teacher at Garfield high school in East Los Angeles, is one
410
ZELTZER
such illustration. His faith, caring, attention, and work with his students, mostly poor and Hispanic, allowed them to have enough faith in themselves to learn calculus and pass the Advanced Placement Calculus Exam. There are many other unsung heroes who have given of themselves to help many other adolescents to develop the courage and selfconviction to attain goals that they otherwise would never have imagined possible. Adolescents who feel this way not only put their best efforts forward to succeed for themselves; but they also often give back to the community to help others. During the past few years, SAM has made tremendous strides. We have taken giant steps in pushing adolescent health into the forefront of health care delivery on national and international levels. We have played a major advocacy role on behalf of our nation's youth in the changes that are unfolding with the new Clinton administration. In this regard, it is noteworthy that our immediate past-president, Dr. Karen Hein, will spend this coming year in Washington as a public policy fellow advocating for youth. I would like to propose, as your incoming President, that we enhance our power as a Society to empower our adolescents, to let them know that "some one cares," that they "matter." I propose that, in order to accomplish this goal, we must do more than research, teaching, clinical service, and advocacy at a national level. We must act as individual SAM members to take a greater role in advocating for youth at a local level in our communities and in mentoring, interacting with adolescents on a one-on-one basis, both within and outside of our traditional professional roles. Each significant contact with an adolescent can be meaningful and hold potential for influencing that life. Often we believe that, in order to be effective, we have to make a contribution on a grand scale, such as heading a Division of Adolescent Medicine, publishing research, getting grants, or creating policy. I contend that the real impact comes in how we contribute to the well-being of the adolescents whom we see as part of our professional lives, those with whom we are involved with through our schools and community activities, and our own children and their friends. I propose two methods for accessing the talent of our membership to accomplish the goal of SAM "making a difference" on behalf of adolescents. The first is that you, as members, individually or through your regional chapters, write to me (addressed to the SAM office) describing what you did to "make a difference". This might relate to voluntary activities
JOURNALOF ADOLESCENTHEALTHVol. 14, No. 5
that you initiated at a school, a program that you set up in your community, or even something that you did with an individual adolescent in which you felt that your involvement "made a difference." I know that you are probably thinking that "Zeltzer is crazy because we make a difference every time that we take care of adolescents through our professional activities." However, there are likely many case examples, programs, voluntary activities known only to individual members. Overcoming obstacles to setting up an afterschool weekly "rap session" program or training teens in peer counseling might be new to one person but not to another. We can use the expertise of our membership to learn from one another for the betterment of the youth of our communities or, preferably more broadly defined, of "our cities." These descriptions often do not find their way into publication unless they emanate from research. While I am certainly not devaluing the importance of such research, I am suggesting that there is another type of critical information that is not typically "publishable" in the traditional sense, so that no one else has the opportunity to learn from these types of experiences and potentially benefit. I am recommending another forum for this material as a trial for one year. I am asking you for your help in describing novel approaches to empower adolescents. What did you do that "made a difference?" I will read each and every letter sent to me and will select, with the help of Dr. LeBaron, our Director of Publications, examples to publish in each SAM newsletter, with our editor Dr. McCabe's help. However, all letters will be saved and compiled into a booklet which we will have on file at the SAM central office. I will also work diligently with publishers to find a way to publish this book, "Making a Difference," so that many can benefit from its contents. The second proposal relates to the fact that SAM's administrative arm will be holding a retreat soon to plan for the direction of SAM activities and focus over the next five years. As your President, I would ask each of you to contribute to the direction of SAM by sending your suggestions and recommendations in writing to me addressed to the SAM office during the next four months. In particular, I would be interested in your thoughts about how we, as a Society, can help empower our membership to be local advocates for adolescents. H o w can we, a Society without much money, use our "people power" and networking abilities and already published written materials to facilitate this effort? This a goal that I believe we can accomplish by strengthening our re-
July 1993
gional chapters and formalizing the relationship between the chapters and SAM. I believe that by giving a greater voice to each individual member of SAM, to our regional chapters, and to our international members and friends, we can better serve as a facilitator for empowering our youth. We are, after all, a large and growing interdisciplinary organization. I would ask each of you to take this year as an opportunity to see what you can do at a local level to "make a difference." If we, SAM, use our collective talents, motivation, and passion for adolescents, we have the ability to make a major contribution to changing our country and lifting it out of its decaying foundations. Finally, but equally important, I also propose that we develop a method for giving a greater voice to adolescents in SAM itself to help guide our directions as a Society advocating for youth. I propose that we consider an adolescent membership in SAM,
MAKING A DIFFERENCE
411
with an adolescent advisory board on our program committee and an adolescent editorial board responsible for an adolescent section of our newsletter. The adolescent involvement in SAM might begin with and be structured through our regional chapters. Thank you all for having the faith in me to elect me as your President. I will offer you my passion for adolescents and my ear so that your voice can help to guide the future directions of SAM. I wish to thank Captain Jack Scapa and family for allowing me to share their time with Rita and for helping to guide the directions of the Society for Adolescent Medicine. This address is dedicated to them and to the courage and love of Rita Scapa.
References 1. The Forgotten Half, November 1988, The William T. Grant Foundation Commission on Work, Family and Citizenship. 2. "Stand and Deliver", starring Edward James Olmos, 1988, Warner Brothers.