SPIRIT OF MAN LECTURE

LOS ANGELES, CA

JUNE 12,199O

C. EVERETT KOOP, MD


GREETINGS, ETC.


IT IS AN HONOR FOR ME TO BE WITH YOU TODAY, TO JOIN THE

RANKS OF THE DISTINGUISHED "SPIRIT OF MAN" LECTURERS. AS

YOUR FORMER SURGEON GENERAL, A PUBLIC HEALTH OFFICER

CONCERNED ABOUT THE WHOLE HEALTH OF THE WHOLE

AMERICAN PEOPLE, I APPLAUD THE COMPREHENSIVE THEME OF


THIS LECTURE SERIES.


OUR JUDEO-CHRISTIAN TRADITION VIEWS HUMAN BEINGS AS A
    lb /W6 44 bo'Ll q%mf~J/WC & r3*+ 4v9 fffq&/#v&.
TRINITY, ------L---..- A SPIRIT.

PHYSICIANS AND OTHER HEALTHCARE WORKERS KNOW WELL

THE BODY AND THE SOUL, BUT SOMETIMES THE SPIRIT OF MAN

SUFFERS FROM NEGLECT, FROM MALNUTRITION.

I AGREE WITH THE PSALMIST: "WE ARE FEARFULLY AND

WONDERFULLY MADE." WE NEED TO NOURISH AND EXERCISE

OUR ENTIRE BEINGS, BODY, SOUL, AND SPIRIT.


- FFER MY REMARKS TODAY IN THE SPIRIT OF CALDWELL
4p
ESSELSTYN, SHARING HIS ASPIRATION THAT SOCIETY'S MOST

PRESSING MEDICAL CARE PROBLEMS WOULD BE ADDRESSED

NOT ONLY BY OUR SCIENTIFIC EXPERTISE, BUT ALSO BY A

NOBILITY OF SPIRIT.

TODAY I'D LIKE TO TALK TO YOU ABOUT SOMETHING THAT WE

ALL ONCE WERE.... SOMETHING TO WHICH WE ALL LOOKED

FORWARD....SOMETHING TO WHICH MANY OF US LOOK BACK

WITH FOND MEMORIES....BUT SOMETHING WE DIDN'T LIKE ALL


THAT MUCH AS IT HAPPENED.

4


"`THAT MAGICAL, NECESSARY, TROUBLED PHASE OF LIFE WE

CALL ADOLESCENCE.


HISTORICALLY SPEAKING, ADOLESCENTS ARE A RATHER RECENT

INVENTION. OF COURSE, THERE HAVE ALWAYS BEEN PEOPLE IN

THE AGE BRACKET WHERE WE NOW FIND ADOLESCENTS --FROM


ABOUT TWELVE UNTIL THE EARLY TWENTIES-- BUT UNTIL


RECENTLY SOCIETY HAD A PLACE FOR ONLY TWO GROUPS:


CHILDREN AND ADULTS.


YOU WERE EITHER ONE OR THE OTHER. AND SOMETIMES THE


ADVERSITIES OF LIFE FORCED CHILDREN TO GROW UP VERY


FAST INDEED.


EVEN IF WE REPLACE THE TRADITIONAL ADULT/CHILD DIVISION

OF SOCIETY BY A


ADOLESCENTS.

TWO WEEKS AGO

GENERATIONAL ONE, WE FIND NO ROOM FOR

WHEN I GAVE THE COMMENCEMENT ADDRESS

AT VASSAR COLLEGE, I LOOKED BEYOND THE YOUNG

GRADUATES SEATED BEFORE ME, TO THE AUDIENCE IN WHICH I

WAS PLEASED TO SEE A LOT OF GREY HEADS. I SAID THAT I WAS

DELIGHTED TO SEE SO MANY GRANDPARENTS THERE, ALONG


WITH PARENTS AND CHILDREN...... BECAUSE MOST OF US SPEND


OUR LIVES IN =)-GENERATIONAL WORLDS.


AS WE GO THROUGH LIFE WE CHANGE PLACES IN THAT 3-
                               70

GENERATIONAL WORLD. AND IT DOESN'T SEEM TAKE LONG FOR

US TO GO FROM ONE GENERATION TO ANOTHER.

I TOLD THOSE YOUNG GRADUATES THAT IT SEEMED LIKE ONLY

YESTERDAY WHEN I WAS RUNNING AROUND THE VASSAR

CAMPUS AS A DARTMOUTH BOY, VISITING THE VASSAR GIRL WHO

WOULD BECOME MY WIFE. NOW MY WIFE AND I HAD RETURNED,

BOTH WITH GREY HAIR, BUT I WARNED THEM THAT IT WOULDN'T
    7pwiJe

BE LONG -HEY WERE THE ONES WITH THE GREY HAIR.


I REMINDED THE YOUNG GRADUATES, THOSE CHILDREN, THOSE

YOUNG ADULTS, THOSE ADOLESCENTS, THAT THEY MUST
                   14 c

ALWAYS REMEMBER THAT WE ALL NEED -OTHER Two

GENERATIONS....AND ARE NEEDED BY THEM.

BUT EVEN IN A THREE-GENERATIONAL VIEW OF SOCIETY --

CHILDREN, PARENTS, GRANDPARENTS-- IT IS HARD TO SEE

WHERE ADOLESCENTS FIT IN.


PERHAPSTHEYBEGANTOCARVEAPLACEFORTHEMSELVESAT

THE BEGINNING OF THIS CENTURY, OR AS LATE AS THE 192OS,

WHEN COMPULSORY SECONDARY EDUCATION STRETCHED OUT

THEIR CHILDHOOD, CHANGED THEM, PERHAPS FROM CHILDREN

TO YOUNGSTERS.

IO


BUT IT WASN'T UNTIL AFTER WORLD WAR II, --THIS

DEVELOPMENT WAS ARTIFICIALLY POSTPONED, FIRST BY THE

GREAT DEPRESSION AND THEN BY THE SECOND WORLD WAR---

WHEN IN THE 1950s MORE AND MORE OF THESE YOUNGSTERS

HAD DISPOSABLE INCOME, WHEN THEY WERE TARGETED BY

ADVERTISERS, WHEN THEY BEGAN TO DEVELOPE THEIR OWN

MUSIC, LIFE STYLES, AND "YOUTH CULTURE"...IT WASN'T UNTIL

THEN THAT WE BEGAN TO HEAR A LOT ABOUT TEENAGERS.

11


AND WE ALSO BEGAN TO HEAR ABOUT THE PARTICULAR

PROBLEMS OF ADOLESCENCE.
    c

SINCE THE CREATION OF A DISTINCT AGE --OR CULTURE-- OF

ADOLESCENCE WE HAVE SEEN TWO OTHER DEVELOPMENTS.

FIRST, A LENGTHENING OF THE ADOLESCENT PHASE OF LIFE,

THROUGH ON ONE HAND THE CREATION OF MORE ADULT

OPPORTUNITIES FOR SOME, THOSE WHO ATTEND COLLEGE AND

EVEN GRADUATE SCHOOL FOR YEARS BEFORE ENTERING THE

ADULT WORKFORCE,

12


AND, IRONICALLY,<HROUGH THE ELIMINATION OF MORE ADULT
OPPORTUNITIES FOR OTHERS, THE HIGH SCHOOL DROP-OUTS,

LANGUISHING IN CHRONIC ADOLESCENT UNEMPLOYMENT.

SO, WE PRODUCE MORE AND MORE ADOLESCENTS, WE KEEP

THEM IN THAT PHASE OF LIFE LONGER AND LONGER, BUT WE

OFFER THEM LESS AND LESS, AND STILL DON'T KNOW WHERE

THEY "FIT IN".

13


NOT REALLY A GENERATION, NOT REALLY A PART OF OTHER

GENERATIONS, THEY SUFFER FROM A STRANGE MIXTURE OF


INDULGENCE AND NEGLECT.

SOCIETY CRITICIZES ADOLESCENTS FOR HAVING NO

EXPECTATIONS, BUT THEN SOCIETY HAS NOT CONVEYED TO


THEM WHAT IT EXPECTS OF THEM.

THERE ARE MANY CRACKS IN OUR SOCIETY, AND ADOLESCENTS

ARE PRONE TO FALL THROUGH THEM.

14


ADDED TO ALL THESE PROBLEMS STEMMING FROM AN

UNCERTAIN PLACE IN OUR SOCIETY, MOST ADOLESCENTS, AT

ONE TIME OR ANOTHER, SUFFER REAL AND UNIQUE PROBLEMS IN


HEALTH.

15


I IMAGINE WE'VE ALL BEEN AROUND HOSPITALS ENOUGH, AS

PATIENTS, VISITORS, OR HEALTHCARE WORKERS, TO HAVE OUR

BLOOD RACE A LITTLE FASTER WHEN WE HEAR THE WORDS


"CODE BLUE".

"CODE BLUE", TWO SHORT WORDS THAT MEAN THAT A LIFE IS


ABOUT TO BE CUT SHORT.

"CODE BLUE" SIGNALS A LIFE-THREATENING SITUATION, AND


SUMMONS ALL THE RIGHT PEOPLE TO THE RIGHT PLACE AT THE

RIGHT TIME....TO SAVE THAT LIFE.

16


"CODE BLUE" IS THE PHRASE USED RECENTLY BY A NATIONAL


COMMISSION ON ADOLESCENT HEALTH --ON WHICH I SERVE AS


CHAIRMAN OF THE NATIONAL SAFE KIDS CAMPAIGN-- TO SIGNAL


THE CURRENT CRISIS IN ADOLESCENT HEALTH.

"CODE BLUE" IS THE URGENT CRY WE MUST HEED TO MEET THIS


DEBILITATING AND YET MOSTLY HIDDEN NATIONAL EMERGENCY.

17


THIS ENDANGERED AGE GROUP IS BUT A FEW YEARS FROM

HAVING A PROFOUND RESPONSIBILITY FOR THE REST OF US, A

PROFOUND IMPACT ON EACH OF US.

IN A FEW YEARS THEY WILL BECOME, NOT ONLY THE LEADERS OF

THIS NATION, BUT ALSO THE PARENTS OF THE NEXT

GENERATION, THE PARENTS OF THE NEXT WAVE OF


ADOLESCENTS.

UNLESS WE RESPOND CORRECTLY TO THE CURRENT CRISIS IN

ADOLESCENT HEALTH WITH COMPASSION, URGENCY AND SKILL,

THE PROBLEMS FOR OUR SOCIETY WILL NOT ONLY ADD UP, THEY

WILL MULTIPLY.

18


AT THE OUTSET WE NEED TO DISABUSE OURSELVES OF SOME


COMMON MISCONCEPTIONS.

FIRST, WE MUST PUT ASIDE THE NOTION THAT ADOLESCENCE IS

A TIME OF NATURAL GOOD HEALTH, A TIME WHEN CHILDREN

BLOSSOM BEAUTIFULLY INTO YOUNG ADULTS, A TIME OF HIGH

ENERGY AND WELL-BEING.

19


NOT TOO LONG AGO, ON ONE OF OUR MOST POPULAR TV

PROGRAMS, THE BILL COSBY SHOW, THE FATHER, AN AGING


TRACK STAR --LIKE COSBY HIMSELF WHO PLAYED THE ROLE--


JOKINGLY TOLD HISWIFE HE HAD SEEN SOMETHING BEAUTIFUL.

"WHAT WAS IT?" SHE ASKED. "NINETEEN," HE SAID..... HE HAD


STOPPED TO WATCH A NINETEEN YEAR-OLD RUNNER SPRINTING

AROUND THE TRACK, AND THAT CONJURED UP AN IMAGE OF

PERFECT HEALTH AND ENERGY. THAT'S NOT THE WAY IT IS FOR


MANY OF AMERICA'S NINETEEN YEAR-OLDS.

20


SECOND, WE MUST SET ASIDE THE ASSUMPTION THAT

ADOLESCENT HEALTH PROBLEMS ARE LIMITED TO COMMUNITIES


PLAGUED WITH HIGH RATES OF CRIME AND POVERTY.

NO, IT IS IN ALL COMMUNITIES, IN EVERY NEIGHBORHOOD

ACROSS THE COUNTRY, THAT WE FIND PROBLEMS AFFECTING

ADOLESCENT HEALTH.

21


TRUE, MANY OF THESE PROBLEMS DO STEM FROM POVERTY.

BUT AFFLUENCE IS NO PROTECTION.

IN FACT, THERE ARE A HOST OF ADOLESCENT HEALTH

PROBLEMS AFFLICTING THE CHILDREN OF AFFLUENCE, THE

OVERLY-DRIVEN CHILDREN OF DEMANDING MIDDLE CLASS

PARENTS: AFFLICTIONS LIKE ANOREXIA NERVOSA, BULIMIA, AND

                                                                      ---

SIMILAR DISORDERS.

22


A GENERATION OR TWO AGO, THE CHIEF THREATS TO THE

HEALTH OF AMERICA'S ADOLESCENTS LAY IN THE VARIETY OF

INFECTIOUS DISEASES TO WHICH THEY MIGHT FALL VICTIM.

BUT AS MEDICAL SCIENCE HAS MADE GREAT STRIDES IN

ERADICATING OR CONTROLLING MANY OF THOSE INFECTIOUS

DISEASES, THE HEALTH OF OUR ADOLESCENTS HAS NOT SHOWN

THE EXPECTED IMPROVEMENT.

23


IN FACT, ADOLESCENTS ARE THE ONE GROUP OF AMERICAN

SOCIETY WHOSE HEALTH HAS NOT SHOWN IMPROVEMENT OVER


THE LAST 70 YEARS.

OUR CHALLENGE TODAY STEMS FROM THE NATURE OF THE


ADOLESCENT HEALTH PROBLEMS.


NO LONGER INFECTIOUS OR OTHER "PHYSICAL DISEASES"


LINGERING OUT THERE TO PREY UPON UNSUSPECTING AND

INNOCENT VICTIMS, THE THREATS TO ADOLESCENT HEALTH LIE


IN THE REALM OF BEHAVIORAL PROBLEMS.

24


IT IS WHAT ADOLESCENTS CHOOSE TO DO THAT BRINGS THEM

TO THE HEALTH PROBLEMS THAT THEY SUFFER.


THE LIST IS ALL TOO FAMILIAR:

DRINKING, SMOKING, AIDS, PREGNANCY, SEXUALLY TRANSMITTED

DISEASES, VIOLENCE, SUICIDE.

TRUE, SOME OF THESE PROBLEMS MAY TECHNICALLY OR

LEGALLY HAVE A PHYSICAL OR BIOLOGICAL BASIS AND HENCE

BE TERMED A DISEASE, BUT THEIR DANGER LIES IN THEIR LINK

WITH ADOLESCENT BEHAVIOR.

25



THIS OF COURSE MAKES TREATMENT AND PREVENTION

DIFFICULT AND COMPLICATED, BECAUSE HEALTH PROBLEMS

STEMMING FROM BEHAVIOR INVOLVE NOT ONLY PHYSICAL

ASPECTS, BUT ALSO THE EMOTIONAL, SOCIAL, AND EVEN

ECONOMIC AND POLITICAL DIMENSIONS AS WELL.

m THIS IS A FACTOR AFFECTING THE HEALTHCARE OF

THE ENTIRE NATION - - THE BLURRING OF PURE MEDICINE AND

THE SOCIO-ECONOMIC MILIEU IN WHICH IT IS PRACTICED.

26


A YEAR OR TWO AGO I WAS ASKED TO TAKE GRAND ROUNDS IN


PEDIATRICS AT A MAJOR TEACHING HOSPITAL.

WHEN I WAS FINISHED LISTENING TO THREE CASES, HAVING

DONE THE BEST I COULD WITH THE PROBLEMS, I HAD TO REMIND

THE RESIDENT STAFF, WHEN THE AUDIENCE LEFT, THAT I WOULD


NOT HAVE GOTTEN AWAY WITH PRESENTING THOSE THREE

YATIENTS THE WAY THEY JUST DID WHEN I WAS IN THEIR

POSITION BECAUSE THEY HAD NOT PRESENTED STRICTLY


MEDICAL PROBLEMS:-- WHAT THEY HAD PRESENTED TO ME


WERE SOCIO-ECONOMIC PROBLEMS THAT HAD COME TO THE


HOSPITAL BECAUSE THE PATIENT HAD AN ILLNESS.

27


THE PROBLEMS OF ADOLESCENT HEALTH OFTEN CAN BE TRACED

TO THE GROWING GAP BETWEEN ADULTS AND ADOLESCENTS IN

COMMUNICATION AND UNDERSTANDING.

ADOLESCENTS SEEM TO THINK DIFFERENTLY.

THEY SEEM TO BE INHERENT RISK-TAKERS.

ALL EVIDENCE TO THE CONTRARY, THEY HAVE A SENSE THAT


THEY ARE IMMORTAL.

Sb THEY HAVE AN SEEMINGLY INSTINCTIVE RESPONSE TO TUNE

OUT ANY ADMONITION THAT BEGINS WITH "DON'T".

28


I SHOULD SAY AT THIS POINT THAT MY CONCERN ABOUT THE


PROBLEMS OF ADOLESCENT HEALTH COMES DIRECTLY FROM MY


TWO MEDICAL CAREERS.

AS YOUR SURGEON GENERAL, AS THE NATION'S CHIEF PUBLIC

HEALTH OFFICER FOR EIGHT YEARS, IT BECAME APPARENT TO

ME THAT MANY OF THE PUBLIC HEALTH ISSUES I DEALT WITH --

SMOKING, AIDS, ALCOHOL, AND SO FORTH-- HAD AN ESPECIALLY

ALARMING ADOLESCENT DIMENSION.

29


AND, FOR FORTY YEARS BEFORE THAT, AS A PEDIATRIC

SURGEON, I BEGAN TO HAVE REAL CONCERNS ABOUT WHAT

WOULD HAPPEN TO THE TINY INFANTS ON WHOM I OPERATED...
                       17

WHEN THEY BECAME ADOLESCENTS. %-GRIEVED ME TO THINK

HOW I AND MY ASSOCIATES CORRECTED LIFE-THREATENING

DEFECTS IN THE FIRST HOURS OR DAYS OF LIFE, ONLY TO HAVE

THAT PRECIOUS LIFE IMPERILED BY ADOLESCENT BEHAVIORAL

HEALTH PROBLEMS.

30


AND THOSE PROBLEMS ARE ALL TOO REAL.

STATISTICS DON'T TELL THE STORY, BUT EVERY SPIRIT OF MAN

LECTURE SHOULD HAVE A FIRM DATA BASE AS A FOUNDATION

FOR ITS CALL TO ACTION. SO, A FEW COMPARISONS, A FEW

NUMBERS:

31


IN 1965 THERE WERE ABOUT 4 CASES OF GONORRHEA AND

SYPHILIS FOR EVERY 1,000 AMERICAN ADOLESCENTS.

IN 1985 THAT NUMBER HAD CLIMBED TO 12 REPORTED CASES

PER 1,000, WITH SO MANY MORE UNREPORTED THAT THE


CENTERS FOR DISEASE CONTROL ESTIMATED THAT EACH YEAR


2.5 MILLION ADOLESCENTS CONTRACT A SEXUALLY TRANSMITTED


DISEASE.

32


IN 1965,16.7 OUT OF 1,000 UNMARRIED GIRLS AGED 15-19 GAVE

BIRTH.

TWENTY YEARS LATER, 31.6 PER 1,000.

AMERICA'S TEENAGE PREGNANCY RATE IS 1 TEENAGE GIRL OUT

OF EVERY 10, A RATE DOUBLE THAT OF ANY OTHER

INDUSTRIALIZED SOCIETY.

33


IN THE 1950s LESS THAN 5% OF YOUNG PEOPLE HAD TAKEN AN

ILLICIT DRUG;

BY 1987, THE NATIONAL ADOLESCENT STUDENT HEALTH SURVEY

INDICATED, 77% OF EIGHTH GRADERS AND 89% OF TENTH

GRADERS HAVE USED ALCOHOL;

15% OF EIGHTH GRADERS AND 35% OF TENTH GRADERS HAVE

USED MARIJUANA;

34


AND AMONG THE CLASS OF 1987,5.6% HAD USED

CRACK-COCAINE.

IN REAL NUMBERS, STANDING FOR REAL PEOPLE, THAT MEANS

MORE THAN 3.5 MILLION YOUNG TEENS (12-17) HAVE USED

MARIJUANA,

AND OF THESE ONE THIRD ARE REGULAR USERS.

OVER HALF A MILLION HAVE USED COCAINE, AND HALF OF THESE

HAVE BECOME REGULAR USERS, OR I SHOULD SAY ABUSERS.

35


SADLY, MANY TEENAGERS DON'T SURVIVE THEIR TEENS.

OVER 50% OF HIGH SCHOOL SENIORS GET DRUNK AT LEAST

ONCE A MONTH, AND THE DEADLY COMBINATION OF DRINKING

AND DRIVING RANKS NUMBER ONE AS A KILLER OF


ADOLESCENTS.

TEN TEENAGERS ARE KILLED EVERY DAY IN ALCOHOL-RELATED

TRAFFIC FATALITIES.

36


SUICIDE RANKS SECOND AMONG KILLERS OF TEENS, WITH 10

PERCENT OF TEENAGE BOYS AND 18 PERCENT OF TEENAGE

GIRLS ATTEMPTING SUICIDE. AND WHILE IT IS TRUE THAT THE

BLACK COMMUNITY SUFFERS A DISPROPORTIONATE BURDEN OF

SOME ADOLESCENT HEALTH PROBLEMS, IT IS IN THE WHITE

POPULATION THAT SUICIDE TAKES IT GREATEST TOLL.

37


HOMICIDE, THE LEADING CAUSE OF DEATH AMONG 15-19 YEAR

OLD BLACKS, CLAIMS 26.6 PER 100,000.

PART OF THAT TERRIBLE PROBLEM CAN BE TRACED TO THE

135,000 AMERICAN TEENAGERS WHO CARRY GUNS TO SCHOOL


EACH DAY.

CRIME AMONG TEENS HAS LED TO A THIRTY-FOLD INCREASE IN

THE NUMBERS ARRESTED SINCE 1960.

38


THE KILLER EPIDEMIC OF AIDS HAS BECOME A SERIOUS THREAT
                    PeFzlC

TO OUR ADOLESCENT POPULATION. AS OF&l990, THERE HAVE
  ZZ~O
BEEN   CASES OF AIDS FROM BIRTH TO 13 YEARS OF AGE.

THERE HAVE BEEN ' c3           CASES IN TEENAGERS 13
       40% r\rwf~ - III *&g&P* 7uQbf pr (uflf, fiflf  ~LlJM
                                                               /A
TO 19 YEARS OF AGE.,m . WITH THE  /kM

LONG INCUBATION PERIOD FOR HIV INFECTION, LOOK TO THE

PREVALENCE OF AIDS IN THE 20-30 YEAR GROUP TO GET AN IDEA

OF WHEN HIV INFECTION TAKES PLACE - IN THE TEEN YEARS.

39


MORE THAN 2 MILLION ADOLESCENTS SUFFER ABUSE AND

NEGLECT REPORTED TO THE AUTHORITIES, BUT PROBABLY AN

EQUAL NUMBER GO UNREPORTED.

AND, OVER HALF A MILLION TEENS ARE RUNAWAYS, ANOTHER

HALF A MILLION AREN'T IN THEIR OWN HOMES BECAUSE THEY

ARE PLACED IN FOSTER HOMES OR OTHER INSTITUTIONS.

42 MILLION ADOLESCENTS HAVE SEVERE PROBLEMS.

40


AND ALL OF, THESE ALARMING FIGURES ARE SPREADING, THEY

ARE SPREADING TO YOUNGER AND YOUNGER TEENS, TO


CHILDREN.

IN EVERY STATE THE AGE AT WHICH CHILDREN BECOME

INVOLVED IN RISKY BEHAVIOR --DRINKING, SMOKING, SEX,


GANGS-- GETS LOWER EACH YEAR.

AN EXAMPLE: IN 1965 ONLY 3% OF GIRLS WERE SEXUALLY

ACTIVE BEFORE THEIR 16TH BIRTHDAY, BUT NOW OVER 15% ARE.

41


LOOKING TOWARD THE OLDER YEARS, WE SEE THE EFFECT OF

THESE BEHAVIOR-LINKED PROBLEMS LASTS LONGER AND


LONGER INTO ADULT LIFE.

THE BEST, THE WORST, EXAMPLE, OF COURSE IS AIDS.

UNPROTECTED SEX AND/OR IV DRUG USE CAN READILY LEAD TO

HIV INFECTION THAT LASTSTHE REST OF A LIFE NOW CUT SHORT
               /&.i' fi. fl I'd., ((4
BY MANY DECADES. OTHE~6i~`CAN LEAD TO LONG-LASTING
                             ,L .._/C' /"

HEALTH PROBLEMS AND EVEN STERILITY.

42


CRACK COCAINE CAN MAINTAIN ITS GRIP ON AN ENTIRE LIFE,

AND ALSO REACH OUT TO RUIN LIVES JUST STARTED, AS THE
                 `To c oc d/ME - 4 iw/~G-
ALARMING INCREASE IN BABIES BORN m

--375,000 OF THESE

PATHETIC INFANTS LAST YEAR.

43


TRAGICALLY, ONE OF THE MOST COMMON RESULTS OF THIS


SELF-DESTRUCTIVE BEHAVIOR IS TO PASS IT ON ALL THE MORE


QUICKLY TO THE NEXT GENERATION.     "

IT IS OFTEN THESE PROBLEM-RIDDEN ADOLESCENTS WHO TEND

TO BECOME PARENTS AT A YOUNGER AGE, AND THEN TO START


THE CYCLE AGAIN.

WE KNOW THAT ABUSED CHILDREN, OFTEN OF ABUSED PARENTS,


BECOME THEMSELVES ABUSERS OF THE NEXT GENERATION.

44


ALCOHOLIC PARENTS PASS ON BEHAVIOR PATTERNS, AND WE

NOW SUSPECT, EVEN GENETIC TENDENCIES, ENCOURAGING

ALCOHOL ABUSE IN THEIR CHILDREN.

AS WITH ANY PROBLEM, WE'D LIKE TO SORT OUT THE CAUSES

AND EFFECTS, FOCUS ON THE CAUSES, AND THEN SOLVE THE


PROBLEMS.

BUT IT IS NOT THAT EASY.

45


UNFORTUNATELY, LISTS OF CAUSES AND SYMPTOMS SEEM TO BE

INTERCHANGEABLE.

I'LL READ OFF A FEW ITEMS FROM LISTS OF FACTORS RELATED

TO ADOLESCENT HEALTH PROBLEMS. SOME OF THESE WERE

LISTED AS CAUSES, SOME AS SYMPTOMS. BUT I'LL MIX THEM UP

AS I READ THEM, AND AS I GO, YOU WILL SEE HOW DIFFICULT IT

IS TO DECIDE WHETHER A CERTAIN ITEM IS A CAUSE OR A  @f 5 -`-

46


SUBSTANCE ABUSE, UNSTABLE FAMILIES, AIDS, EARLY

PREGNANCIES, POOR PARENTING SKILLS, EMOTIONAL

DYSFUNCTION, POOR PEDIATRIC CARE, ETHNIC HOSTILITY,

POVERTY, VIOLENT BEHAVIOR, POOR SELF IMAGE, POOR

MATERNAL HEALTH CARE,  EDUCATIONAL FAILURE, LONELINESS,


STRESS....

WELL, YOU GET THE PICTURE.

47


AT THE TOP OF THE LIST OF CHRONIC PROBLEMS, FINDING ITS


CENTRAL PLACE IN THE CIRCLE OF CAUSE AND EFFECT IS


POVERTY . . . . .

THE ALARMING AND RAPID INCREASE IN POVERTY, ESPECIALLY


AMONG CHILDREN.


TWENTY FIVE PERCENT OF THE ADOLESCENTS OF THE 1990s ARE


ALREADY LIVING IN POVERTY.


THAT REFLECTS A NATIONAL POVERN RATE TWO OR EVEN


THREE TIMES HIGHER THAN THAT OF OTHER INDUSTRIALIZED


SOCIETIES.

48


ONE HALF OF ALL BLACK AND HISPANIC CHILDREN UNDER 6 ARE

POOR.

IN THE LAST FIVE YEARS, THE NUMBER OF FAMILIES IN POVERTY

HAS GROWN BY FORTY PERCENT, WITH FAMILIES BECOMING THE

FASTEST GROWING SEGMENT OF THE HOMELESS POPULATION.

49


[HERE, CEK CONVERSATION WITH HOMELESS KIDS.]

50



ALL THIS AMOUNTS TO POORER HOUSING, UNSAFE LIVING

ENVIRONMENTS,  . . . . . POORER HEALTH FOR AMERICA'S


ADOLESCENTS......

MORE STRESS ON FAMILIES.

AND THIS COMES AT A TIME WHEN FAMILIES ARE LESS ABLE TO

BEAR STRESS.

51


THERE ARE SIGNIFICANT CHANGES IN TRADITIONAL FAMILY


STRUCTURES AND ROLES.

THE AMERICAN FAMILY, AS WE HAVE KNOWN IT EARLIER IN THIS

CENTURY, HAS FALLEN APART.

IN 1965 11.3% OF AMERICAN CHILDREN LIVED IN SINGLE-PARENT

HOMES. BY 1987 21% OF AMERICANS UNDER 18 LIVED IN HOMES

WITH A SINGLE PARENT.

52


DIVORCE, REMARRIAGE, DESERTION BY ONE PARENT OR THE

OTHER.... ALL THIS HAS TORN FAMILIES APART, AND LEAD TO THE

RESTRUCTURING OF FAMILIES IN NEW, SKELETAL, AND OFTEN


DYSFUNCTIONAL FORMATIONS.

GENERATIONAL LINES ARE BLURRED BECAUSE GRANDMOTHER,

MOTHER AND GRANDCHILD ALL HAVE CHILDREN BEING RAISED


TOGETHER.

53


PARENTS INCREASINGLY DON'T ASSUME PARENTAL FUNCTIONS.

IN SOME CASES THIS IS BECAUSE THEY ARE TOO YOUNG, e

CHILDREN HAVING CHILDREN, BUT IN OTHER CASES THE

PARENTS MANIFEST ILL-HEALTH, PERSONAL EMOTIONAL

TRAUMA, AND THE INABILITY, OR EVEN UNWILLINGNESS TO COPE.

54


AS THE MIDDLE CLASS II) SHRINKS, LARGER NUMBERS OF

FAMILIES HAVE FEWER RESOURCES FOR SURVIVAL.

AND AS NUCLEAR FAMILIES BREAK DOWN, THE NEXT LEVEL OF

SUPPORT --EXTENDED FAMILIES AND NEIGHBORHOODS--

SUFFER SIMILAR DISINTEGRATION IN A MORE URBANIZED, MORE

MOBILE, MORE ANONYMOUS AMERICAN CULTURE.

55


THIS MEANS THAT WITH EACH PASSING YEAR, AMERICAN

CHILDREN AND ADOLESCENTS HAVE LESS AND LESS CONTACT


WITH ADULTS.

PARENTS WORK, RELATIVES AND NEIGHBORS MOVE AWAY OR

ARE DISINTERESTED, YOUNGSTERS ARE LEFT ALONE.

THE AVERAGE CHILD SPENDS LESS THAN AN HOUR A DAY WITH

HER OR HIS MOTHER, AND LESS THAN 5 MINUTES WITH THE

FATHER. AND MANY DON'T HAVE ONE PARENT AROUND AT ALL.

56


EVEN WHEN BOTH PARENTS ARE PRESENT WE SEE AN ALARMING

TENDENCY TO PASS THE BUCK OF PERSONAL RESPONSIBILITY.

PARENTS LEAVE TO THE SCHOOLS THE ENTIRE TASK OF

EDUCATING THEIR CHILDREN, WHEN NOT LONG AGO PARENTS

CLAIMED THE EDUCATION OF THEIR CHILDREN TO BE THEIR

PRIVILEGE AND OBLIGATION, EVEN IF SHARED WITH THE


SCHOOLS.

57


CHILDREN LIVE IN THEIR OWN CULTURE, REMOTE FROM ADULTS,

DOMINATED ONE YEAR BY TRANSFORMER TOYS, THE NEXT BY

CABBAGE PATCH DOLLS, THE NEXT BY TEENAGE MUTANT NINJA


TURTLES.

THEY LEAD LIVES DETACHED FROM PARENTAL CONCERN OR

INTEREST, TURNING TO PEERS FOR THE GUIDANCE OR EVEN

PLAYFUL COMPANIONSHIP THAT PARENTS AND GRANDPARENTS

USED TO PROVIDE.

58


INTO THE VACUUM CREATED BY THE ABSENCE OF ADULTS HAVE

MOVED TELEVISION, RADIO, MOVIES, AND VIDEOS, OFTEN WITH A

CONSTANT MESSAGE OF SEX, VIOLENCE, AND GREED.

RELIGIOUS TEACHING AND ETHICAL VALUES, IF THEY ARE

INSTILLED AT ALL, ARE NOW LEFT TO CHURCH OR SYNAGOGUE..

. OR MTV.

59


AS WE MOVE INTO THE LAST DECADE OF THE TWENTIETH

CENTURY, OUR NATION HAS YET TO ENACT A NATIONAL YOUTH


AGENDA THAT

ADDRESSES THE NEEDS OF ADOLESCENTS COMPREHENSIVELY.

EXISTING SERVICE DELIVERY SYSTEMS DO NOT FUNCTION IN


WAYS THAT CHERISH AND PROVIDE FOR ADOLESCENTS AND


THEIR FAMILIES. IT IS TIME TO RE-EXAMINE THE WAYS IN WHICH


WE LOOK AT ADOLESCENTS AND THEIR SPECIAL HEALTH


PROBLEMS -- TO REALLOCATE RESOURCES AND TO REDESIGN

SERVICE DELIVERY SYSTEMS IN WAYS THAT HELP ALL OF OUR

YOUNG PEOPLE, AND THEIR FAMILIES, COPE WITH THE


CHALLENGES ASSOCIATED WITH BECOMING WELL-EDUCATED


AND HEALTHY CITIZENS.

60


WHAT CAN WE DO?

WELL, I'VE GIVEN THIS A LOT OF THOUGHT, ESPECIALLY IN THE

LAST FEW WEEKS WHEN I HAVE SPENT SO MUCH TIME WITH

ADOLESCENTS, INTERVIEWING THEM IN CONNECTION WITH MY

COMING NBC TV PRIMETIME SPECIAL ON ADOLESCENT HEALTH.

61


I'LL MAKE A FEW SUGGESTIONS, BASED UPON THE EYE-OPENING

FILMING OF THE LAST FEW WEEKS, BASED UPON MY YEARS AS A

SURGEON OF CHILDREN AND ADOLESCENTS, AND BASED UPON


MY EXPERIENCE AS YOUR SURGEON GENERAL.

62


IN THAT LAST CAPACITY, ALTHOUGH I MAY HAVE RECEIVED

PUBLIC ATTENTION FOR MY EFFORTS AGAINST AIDS, SMOKING,

AND DRUNK DRIVING, I TAKE THE GREATEST SATISFACTION FOR


AN INITIATIVE I WAS PRIVILEGED TO LEAD THAT REDESIGNED THE


WAYS IN WHICH CHILDREN WITH SPECIAL HEALTH NEEDS --


SOME CALLED THEM HANDICAPPED CHILDREN-- COULD TAKE


ADVANTAGE OF THE TANGLED WEB OF HEALTHCARE AND SOCIAL


SERVICE AGENCIES THAT MIGHT HELP THEM.

63


THOSE OF US INVOLVED IN THIS INITIATIVE FOR SPECIAL NEEDS


CHILDREN WANTED TO MAKE SURE THE SERVICES WERE

PLANNED AROUND THE NEEDS OF THE PEOPLE WHO NEEDED

THEM, RATHER THAN FORCING THE PEOPLE TO ADAPT TO THE


SERVICES.

WE NEED THE SAME APPROACH FOR ADOLESCENT HEALTH

PROBLEMS.

64


A FEW SIMPLE CONCEPTS SHOULD GUIDE US.

ALL OUR EFFORTS SHOULD BE:

FAMILY-CENTERED

COMMUNITY-BASED

CULTURALLY SENSITIVE

COORDINATED

CONFIDENTIAL

ADEQUATELY FINANCED.

65


FIRST, FAMILY-CENTERED:

EVEN THOUGH THE BELEAGUERED AMERICAN FAMILY IS OFTEN

UNLIKE THAT IDEAL FAMILY OF THE STORY BOOKS, WE NEED TO

DEAL WITH THE FAMILIES OF ADOLESCENTS, IN THEIR VARIOUS

PERMUTATIONS, THE WAY WE FIND THEM, NOT THE WAY WE


WOULD WISH THEM TO BE.

EVEN THOUGH FRAGMENTED, THE FAMILY IS THE CONTINUOUS

PRESENCE IN THE LIFE OF THE ADOLESCENT.

66


FAMILIES, EVEN IN UNUSUAL FORMS, SHOW A STEELY

RESILIENCE. IN WHATEVER SERVICES WE OFFER THE

ADOLESCENT, WE MUST INCLUDE THE FAMILY,THE

DEVELOPMENT AND APPLICATION OF POLICIES THAT AFFECT

ADOLESCENT HEALTH CARE. SERVICES MUST BE FLEXIBLE AND


RESPONSIVE TO FAMILIES.

WE NEED TO VIEW FAMILIES AS PRIMARY CARE PROVIDERS, AND

GIVE THEM THE INFORMATION AND SUPPLIES THEY NEED TO DO


THIS JOB.

67


WE NEED TO PAY HEED TO THE SINGLE PARENT FAMILIES OR

AGGREGATE FAMILIES.

IF WE FIND FAMILIES WEAK, WE NEED TO STRENGTHEN THEM.

WE NEED TO STRENGTHEN PARENTING SKILLS, REMEMBERING

THAT IN SOME DYSFUNCTIONAL FAMILIES THE PARENT ROLE MAY

BE ASSUMED BY AN OLDER SIBLING OR EVEN A SURROGATE


ADULT.

68


FURTHERMORE, OUR CONCERN FOR FAMILIES MUST ENCOMPASS

AN AFFIRMATION OF BASIC VALUES. HEALTH IS A MATTER OF

THE SPIRIT AS WELL AS THE BODY. PROVISION OF A SPIRITUAL,

A RELIGIOUS DIMENSION AMONG THE SERVICES OFFERED


ADOLESCENTS AND THEIR FAMILIES WILL REAP LASTING


REWARDS.

69


OUR CONCERN FOR ADOLESCENTS MUST BE


CULTURALLY SENSITIVE:
/

SERVICES NEED TO BE SENSITIVE TO DIFFERENT CULTURAL

VALUES AND CUSTOMS. FOR EXAMPLE, MORE THAN 80% OF

CHILDREN WITH HIV INFECTION ARE BLACK OR HISPANIC.

SERVICES MUST FOCUS ON THE STRENGTHS AND NEEDS OF

THESE GROUPS. MINORITY LEADERS SHOULD BE CENTRAL IN

PLANNING AND STARTING SYSTEMS OF SERVICES FOR CHILDREN


AND THEIR FAMILIES.
        /

70


EVEN AFTER A GENERATION OF LEGISLATIVE, JUDICIAL AND

PERSONAL EFFORTS TO ELIMINATE RACIAL INEQUALITY, AMERICA

IS STILL PLAGUED BY RACISM, AND THERE ARE MANY WHO SEE


ETHNIC HOSTILITY AND DISCRIMINATION ONLY INCREASING IN

THE YEARS IMMEDIATELY BEFORE US.

DESPITE THE FACT THAT OUR COMMUNITIES ARE MORE

CULTURALLY DIVERSE, SOCIAL INSTITUTIONS HAVE NOT ADAPTED


TO THESE CHANGES. PROFESSIONAL INSENSITIVITY TO


CULTURAL DIFFERENCES AND LANGUAGE


BARRIERS IMPEDE ACCESSIBILITY TO SERVICES FOR


CULTURALLY DIFFERENT FAMILIES AND ADOLESCENTS.

71


AS WE KEEP OUR FINGER ON THE PULSE OF THE FAMILY, AS WE

ARE SENSITIVE TO CULTURAL DIFFERENCES, WE NEED TO

GROUND OUR SERVICES IN THE COMMUNITY.

COMMUNITY-BASED SERVICES ARE THE KEY TO WINNING THE


STRUGGLE AGAINST ADOLESCENT HEALTH PROBLEMS.

72


OUR COUNTRY IS RECOGNIZED INTERNATIONALLY FOR

SOPHISTICATED TERTIARY CARE AND TECHNOLOGICAL

ADVANCES; YET WE LACK ACCESS AND EQUITY FOR BASIC

SERVICES AT THE FAMILY AND COMMUNITY LEVEL. WE ARE THE

ONLY DEVELOPED NATION THAT DOES NOT GUARANTEE HEALTH

CARE TO EVERY CITIZEN1 k 1 "lp,d   I/?- '  EiC CPP"/iafl t!4 F-

SERVICES NEED TO BE PROVIDED IN OR NEAR THE HOME

COMMUNITIES OR NEIGHBORHOODS OF CHILDREN AND THEIR

FAMILIES. FAMILIES SHOULD NOT HAVE TO TRAVEL LONG

DISTANCES FOR SERVICES. AND WHENEVER POSSIBLE,

CHILDREN SHOULD BE CARED FOR AT HOME RATHER THAN IN A

HOSPITAL.

73


I HAVE BECOME CONVINCED THAT FINDING THE RIGHT PLACE

FOR ADOLESCENT HEALTH CARE WILL WIN HALF THE BATTLE.

EVEN WHEN ADOLESCENTS DECIDE TO SEEK A PHYSICIAN,

FINDING A DOCTOR IS USUALLY A LOST CAUSE FOR MANY OF

THEM.

I SPENT MUCH OF MY PROFESSIONAL LIFE MAKING SURE THAT

CHILDREN WITH SURGICAL PROBLEMS CONTINUED TO RECEIVE

GOOD COMPREHENSIVE CARE IN THE ADULT WORLD, SO I KNOW

THAT ONE OF THE PERSISTENT PROBLEMS OF AMERICAN

MEDICINE IS THE DIFFICULTY OF TRANSITION BETWEEN


PEDIATRIC AND ADULT MEDICAL CARE.

74


SOME ADOLESCENTS DON'T LIKE TO KEEP GOING TO THEIR

PEDIATRICIANS, THE "BABY DOCTOR", AND SOME PEDIATRICIANS

ARE GLAD, FROM A PROFESSIONAL IF NOT PERSONAL POINT OF

VIEW, TO SEE THEM MOVE ON.

OTHER ADOLESCENTS ARE RELUCTANT TO CHANGE, WHILE SOME


PEDIATRICIANS FEEL TOO MUCH OF A PROPRIETARY INTEREST IN

THEIR GROWING PATIENTS, AND CLING TO ADOLESCENTS WHO

WOULD BE BETTER SERVED IN AN ADULT PRACTICE.

75



BUT THEN, MANY INTERNISTS WITH AN ADULT PRACTICE ARE NOT

THAT ANXIOUS TO TAKE ON ADOLESCENTS AS PATIENTS.

SO, AGAIN THEY FALL THROUGH THE CRACKS.

76


SERVICES MUST NOT SIMPLY BE IN THE COMMUNITY --AS

IMPORTANT AS THAT IS-- THEY MUST ALSO BE


COORDINATED

ONE OF THE MAJOR PROBLEMS IN DEALING WITH ADOLESCENT

HEALTH NEEDS IS THE PROBLEM OF FRAGMENTED SERVICES.

77


SO FAR THE RESPONSE OF CONCERNED CITIZENS AND

LEGISLATORS HAS BEEN TO SET UP A NUMBER OF PROGRAMS

OR SERVICES, EACH DESIGNED TO DEAL WITH A SPECIFIC

PROBLEM: AIDS, CHILD ABUSE, TEENAGE PREGNANCY, DRUGS,

AND SO FORTH.

BUT THE LACK OF COLLABORATION BETWEEN THESE PROGRAMS

CAN BLUNT THEIR SUCCESS, OR EVEN DOOM THEM TO FAILURE.

BUREAUCRATIC MYOPIA, RIGID REPORTING PROCEDURES,

OVERLY RESTRICTED FUNDING, AND PLAIN INSENSITIVITY TO THE

LARGER PICTURE OF THE ADOLESCENT'S WORLD CAN DOOM THE

BEST INTENDED PROGRAM.

78


FRAGMENTATION OF SERVICES CAN LEAD TO BITTER

FRUSTRATION.

FOR EXAMPLE, AN ADOLESCENT WHOSE NEEDED MEDICAL CARE


IS PAID FOR BY MEDICAID CAN LOSE ELIGIBILITY FOR MEDICAID


IF HIS MOTHER GOES TO WORK OR REMARRIES.

OR A TEEN ALCOHOL ABUSER MAY FINISH AN ALCOHOL ABUSE

PROGRAM, BUT IN THE MEANTIME HAS TAKEN TO COCAINE,

BECAUSE THE PROGRAM HAS NOT TOUCHED THE BASIC


BEHAVIORAL PROBLEM.

79


A TEENAGE MOTHER MAY BE DENIED ENTRY INTO A PARENTING

PROGRAM BECAUSE SHE HAS NOT DROPPED OUT OF SCHOOL

ADOLESCENTS AND FAMILIES TO PREVENT GAPS IN SERVICE, AND

TO KEEP SERVICES FROM BEING PROVIDED SEPARATELY FROM

EACH OTHER.

STRONG LEADERSHIP AND COMMITMENT ARE NEEDED AS

PEOPLE AND GROUPS WORK TOGETHER TO IMPROVE DELIVERY

OF SERVICES.
    /

80


THE FURTHER THE ADMINISTRATION OF THE PROGRAMS GET

FROM THE LOCAL LEVEL, THE LESS SUCCESSFUL THEY WILL BE.

LOCAL GROUPS SEE THE LOCAL PROBLEMS THE MOST CLEARLY.

/

THEY NEED TO BE GIVEN THE POWER AND THE FUNDS TO DO

WHAT NEEDS TO BE DONE FOR THEIR YOUNG PEOPLE. THEY

KNOW HOW TO LINK SELF-HELP GROUPS WITH HEALTH

PROGRAMS. THEY ARE THE ONES WHO CAN INSURE

COLLABORATION WITHOUT BAFFLING COMPLEXITY.
               /

81


THE PLACE WE NEED THE GREATEST COORDINATION, THE

CLOSEST COLLABORATION, IS BETWEEN THE HEALTHCARE

SERVICES AND THE SCHOOLS;/

THE CLOSE CONNECTION BETWEEN THE PROBLEMS OF

ADOLESCENT HEALTH AND THE PROBLEMS OF ADOLESCENT

EDUCATION HOLD THE PERIL OF COMMON DESTRUCTION..... OR


THE OPPORTUNITY OF JOINT SOLUTION.

82


THOSE ADOLESCENTS WHO HAVE GOOD HEALTH, A STRONG

SELF-IMAGE, WHO ARE PHYSICALLY FIT, WILL BE LESS INCLINED

TO RISK A BRIGHT FUTURE BY ENGAGING IN RISKY BEHAVIOR, IN


DRUG OR ALCOHOL ABUSE.

BUT THE ADOLESCENT DOING POORLY IN SCHOOL, FACING A

DARK FUTURE, MAY READILY SEEK ESCAPE IN DRUGS, ALCOHOL,

GANGS, AND THEN OF COURSE, FALL EVEN FURTHER BEHIND.

83


A MINNESOTA STATE-WIDE STUDY CONFIRMED THAT

ADOLESCENTS WITH LOW GRADES IN SCHOOL WERE TWO TO

FIVE TIMES MORE LIKELY TO SMOKE DAILY, USE ALCOHOL

EXCESSIVELY, BE SEXUALLY PROMISCUOUS, AND ATTEMPT

SUICIDE THAN TEENS WITH ABOVE-AVERAGE GRADES. THIS

FINDING WAS ACROSS THE BOARD, FOR ALL RACIAL AND ETHNIC


GROUPS.

84


IT IS FOOLHARDY FOR AMERICANS TO BE CONCERNED ABOUT


THE AMERICAN SCHOOLS WITHOUT SIMILAR CONCERN FOR THE


HEALTH OF AMERICAN SCHOOL CHILDREN AND ADOLESCENTS.

HEALTH AND EDUCATION CAN NO LONGER BE TREATED AS

SEPARATE SPHERES.

ALL TOO OFTEN, TODAY, THE SCHOOL NURSE, THE NUTRITION

COUNSELOR, THE PHYSICAL EDUCATION PROGRAMS ARE SIMPLY


NOT MEETING THE REAL HEALTH NEEDS OF ADOLESCENT

STUDENTS.

85


FOR EXAMPLE SUCCESSFUL "MAINSTREAMING" SPECIAL NEEDS

STUDENTS REQUIRES INTENSE COLLABORATION BETWEEN


HEALTH AND EDUCATION PERSONNEL.

EDUCATIONAL AND HEALTH SERVICES DEAL WITH MANY OF THE

SAME PROBLEMS, SO THEY SHOULD GET THEIR ACTSTOGETHER.

86


/
BUT F E NEED SCHOOL-HEALTH COORDINATION NOT ONLY

BECAUSE THE PROBLEMS ARE INTERTWINED, BUT ALSO

BECAUSE FOR HEALTH SERVICES ~0 * REACH ADOLESCENTS

THEY MUST BE CONVENIENT TO USE.

AND SINCE SCHOOL IS ONE PLACE THE ADOLESCENT SHOULD BE,

IT IS THE BEST PLACE TO LOCATE A PRIMARY HEALTHCARE

FACILITY. AND MAYBE HAVING THE SCHOOL AND CLINIC

TOGETHER WILL MAKE THE ADOLESCENT MAKE BETTER USE OF


EACH.

87


RIGHT NOW, THINGS DO NOT OPERATE VERY EFFECTIVELY.

AT POLICY AND POLITICAL LEVELS WE HAVE RESPONDED WITH

SINGLE ISSUE OR CATEGORICAL PROGRAMS AS EACH HUMAN

SERVICE CONCERN IS BROUGHT TO NATIONAL ATTENTION. IN

THIS COUNTRY, HEALTH AND EDUCATION SERVICES ARE

PROVIDED BY A COMPLEX MIX OF PUBLIC, PRIVATE AND

VOLUNTARY AGENCIES AND ORGANIZATIONS.

8%


WE MUST DEVELOP NEW ORGANIZATIONAL RELATIONSHIPS

AMONG SCHOOLS, PHYSICIANS, PUBLIC HEALTH AGENCIES AND

SOCIAL SERVICE ORGANIZATIONS. IN ADDITION, FEDERAL AND

STATE SYSTEMS MUST ALLOCATE NECESSARY RESOURCES AND

ESTABLISH CONDITIONS THAT FACILITATE THE DEVELOPMENT OF

THESE NEW ORGANIZATIONAL RELATIONSHIPS IN LOCAL


JURISDICTIONS.

89


WE MUST ORGANIZE HEALTH AND EDUCATION SERVICES IN WAYS

THAT ACKNOWLEDGE THE COMPLEXITY OF SOCIAL

ENVIRONMENTS AND ADDRESS SUCH CONCERNS AS THEY


EMERGE.

AS THE NEEDS OF CHILDREN AND FAMILIES EXPAND AND

BECOME MORE COMPLEX, IT IS MORE AND MORE APPARENT

THAT BOUNDARIES OF PROFESSIONAL RESPONSIBILITY AS

REFLECTED IN OUR EXISTING SERVICE DELIVERY SYSTEM ARE

OFTEN DYSFUNCTIONAL.

90


THERE ARE SEVERAL POPULATIONS OF ADOLESCENTS


CURRENTLY BEING SERVED INDEPENDENTLY BY HEALTH AND

EDUCATION PROVIDERS. INSTEAD, WE MUST MAKE CHANGES IN

THE SERVICE SYSTEM THAT ALLOW PROFESSIONALS TO PROVIDE

SERVICES TO ADOLESCENTS AND FAMILIES COLLABORATIVELY


BECAUSE OF THE CHANGING SOCIAL CONTEXT WHERE


ADOLESCENTS COME TO SCHOOL WITH EDUCATIONAL


PROBLEMS WHOSE ORIGINS AND SOLUTIONS LIE AS MUCH IN


THE AREA OF HEALTH AS IN EDUCATION.


HEALTH AND EDUCATION SERVICE PROVIDERS MUST CREATE

CHANGES IN THE EXISTING SERVICE DELIVERY SYSTEM THAT

ENABLE EFFECTIVE COLLABORATION.

91


OUR MANY FRAGMENTED ATTEMPTS TO DEAL WITH THE HEALTH

AND EDUCATIONAL PROBLEMS OF ADOLESCENTS HAVE

PRODUCED AT LEAST ONE GOOD MODEL OF A COORDINATED

PROGRAM.   THE SPECIAL EDUCATION EXPERIENCE OF THE

LAST TWO DECADES IS ONE EARLY EFFORT TO ENCOURAGE

COOPERATION BETWEEN HEALTH AND EDUCATION

PROFESSIONALS.

92


f :'

P.L. 94-142 INSURED THE PROVISION OF FREE, APPROPRIATE

PUBLIC EDUCATION SERVICES TO CHILDREN WITH SPECIFIC

HANDICAPPING CONDITIONS. IT ALSO OUTLINED A PROCESS

WHEREBY THESE CHILDREN WOULD, TO THE EXTENT POSSIBLE,

BE EDUCATED IN THE LEAST RESTRICTIVE ENVIRONMENT.

BECAUSE MANY OF THESE CHILDREN WERE MEDICALLY FRAGILE

OR HAD SPECIAL HEALTH NEEDS, HEALTH PROFESSIONALS
BECAME INVOLVED IN DESlGNlNGkfAND OFTEN IMPLEMENTINGI';

INDIVIDUAL EDUCATION PLANS FOR EACH CHILD.

93


IN EFFECT, THE LEGISLATION MANDATED COOPERATION

BETWEEN HEALTH AND EDUCATION PROFESSIONALS,AND

SYSTEMS WERE PUT INTO PLACE TO STREAMLINE THIS SERVICE


COORDINATION IN WAYS THAT WOULD BEST ADDRESS THE


NEEDS OF THIS CATEGORICAL PROGRAM .

P.L. 94-142 DEMONSTRATED THE NEED FOR A BETTER WAY TO


COORDINATE A BROAD RANGE OF SERVICES FOR CHILDREN WITH


HANDICAPPING CONDITIONS.

94


WHILE IT DID NOT FORMALLY ENCOURAGE COLLABORATION

BETWEEN THOSE WHO PROVIDE HEALTH AND EDUCATION

SERVICE, IMPLEMENTORS IDENTIFIED SEVERAL ISSUES RELATED

TO SERVICE COORDINATION THAT NEEDED TO BE ADDRESSED IN

ORDER TO BETTER SERVE THE TARGETED POPULATION.

FOR THE FIRST TIME IN THE FEDERAL EDUCATION LEGISLATIVE

PROCESS, STATES WERE CHALLENGED TO MAKE CHANGES IN

EXISTING SERVICE SYSTEMS THROUGH A COORDINATED,

MANAGED EARLY INTERVENTION PROCESS.

95


SOME OF THE MOST CREATIVE EXAMPLES OF COLLABORATION

BETWEEN EDUCATION AND HEALTH PROFESSIONALS CAN BE

FOUND IN THE EXTENSIVE INTERAGENCY PLANNING PROCESS

THAT IS NOW OCCURRING AS STATES CREATE SERVICE DELIVERY

SYSTEMS IN LOCAL JURISDICTIONS FOR INFANTS AND TODDLERS

WITH HANDICAPS AND THEIR FAMILIES.

IN SUCH A SYSTEM, PUBLIC AND PRIVATE HEALTH, EDUCATION

AND SOCIAL SERVICE PROFESSIONALS COORDINATE THEIR

SERVICES IN THE INTERESTS OF CHILDREN AND FAMILIES

RATHER THAN IN THE INTERESTS OF THE SERVICE SYSTEMS. IN

THIS WAY, ADEQUATE RESOURCES ARE GARNERED AND

PROVIDERS ARE APPROPRIATELY SUPPORTED AND REIMBURSED.

96


COORDINATING THE SCHOOLS AND HEALTHCARE SERVICES WILL

MEAN SHELVING SOME OLD SUSPICIONS.

ONCE I TRIED TO GET SOME SCHOOL-BASED CLINICS GOING IN _
fi'LW*uR'b , BUT IMMEDIATELY RAN INTO OPPOSITION BECAUSE

MOST PEOPLE ASSOCIATED SCHOOL-BASED CLINICS

EXCLUSIVELY WITH CONTRACEPTION AND PREGNANCY ISSUES.

ACTUALLY, GOOD SCHOOL-BASED CLINICS FIND THAT

CONTRACEPTION OR PREGNANCY ISSUES AMOUNT TO ONLY 6

PERCENT OF THEIR WORK.

97


ANOTHER GOOD REASON TO PLACE CLINICS AND SCHOOLS

TOGETHER IS THAT IT WILL ENABLE HEALTH CONSULTATIONS TO


OCCUR WITH GREATER


CONFIDENTIALITY.

CONFIDENTIALITY IS ESSENTIAL.

THERE IS A PERVASIVE DISTRUST IN THE ADOLESCENT

COMMUNITY.

98


WHEN I WAS FILMING FOR THE TV SPECIAL ON ADOLESCENT

HEALTH, I ARRANGED FOR SOME CANDID TALK WITH KIDS IN

MINNEAPOLIS. MEETING WITH THEM INVOLVED GOING THROUGH

STEPS LIKE THOSE WE SEE IN MOVIES ABOUT THE MAFIA:
         d-                4&P&J  ~~/F$wl4 bfk"' Rwc
         RESTAURANT&             E





                             , AND SUSPICION SO THICK YOU COULD

CUT IT WITH A KNIFE.

99


MY INITIAL GREETING BY ONE OF THESE YOUNGSTERS WAS, "I


DON'T TRUST YOU. I DON'T LIKE YOU. YOU WORKED FOR THE

GOVERNMENT, SO YOU MUST BE A LIAR."

/

OBVIOUSLY, DISTRUST OF PUBLIC OFFICIALS MUST BE


OVERCOME IF WE EXPECT THE PUBLIC SECTOR TO HAVE A

POSITIVE IMPACT UPON ADOLESCENTS AND THEIR HEALTH.

ASSURING CONFIDENTIALITY IS ESSENTIAL.
             /

100



ADOLESCENT FEAR OF LACK OF CONFIDENTIALITY IS A MAJOR

REASON WHY THOUSANDS OF ADOLESCENTS AVOID HEALTH

CARE FACILITIES.

EVEN THOSE WHO CAN AFFORD MEDICAL CARE BECAUSE THEY

ARE COVERED BY THEIR PARENTS' INSURANCE WILL AVOID

NEEDED HEALTH CARE IF INSURANCE COVERAGE MEANS A

BREACH OF CONFIDENTIALITY.

TRUE, PARENTAL INVOLVEMENT IN ADOLESCENT HEALTH IS

IMPORTANT, BUT IT CANNOT BE ALLOWED TO STAND IN THE WAY

OF ADOLESCENT HEALTHCARE.

/

101


AS IS THE CASE WITH SO MANY PROBLEMS, SOONER OR LATER

WE NEED TO TALK ABOUT MONEY.

ADOLESCENT HEALTH CARE MUST BE

ADEQUATELY FINANCED.

102


ALL ADOLESCENTS NEED TO BE GUARANTEED ACCESS TO

HEALTH CARE, REGARDLESS OF ABILITY TO PAY.


IT IS A NATIONAL TRAVESTY TO HAVE SO MANY OF OUR CITIZENS


LIVE AMID THE SIGNS OF AFFLUENCE AND OPULENCE, BUT


UNABLE TO AFFORD BASIC HEALTH CARE.

FAR TOO OFTEN ACCESS TO HEALTH CARE FOR ADOLESCENTS

DEPENDS ON THE FAMILY'S FINANCIAL CIRCUMSTANCES, AND


EVEN UPON THE STATE IN WHICH THOSE CIRCUMSTANCES

OCCUR.

103


ABOUT 15 PERCENT OF ALL 10 TO 18 YEAR-OLDS LACK PUBLIC

FINANCING OR PRIVATE INSURANCE FOR HEALTH CARE COSTS.

IN FAMILIES LIVING UNDER THE POVERTY LEVEL, FULLY 35

PERCENT OF SCHOOL AGE CHILDREN LACK HEALTH INSURANCE.

THERE IS A-DIFFERENCE BETWEEN BEING

INDIGENT AND BEING MEDICALLY INDIGENT. / I toYV&f

104


i FOR EXAMPLE) THE POVERTY LEVEL ESTABLISHED BY THE

FEDERAL GOVERNMENT FOR A FAMILY OF 3 IS $10,500.

BUT m STATES,                 DECLARE THAT
                            /t+ pMwmw~~

POVERTY LEVEL TO QUALIFY FOR MEDICAID SHALL BE

THE NATIONAL LEVEL.

m, IF A FAMILY OF THREE IN TEXAS EARNS MORE

THAN $3,000 ANNUALLY, THEY ARE TOO RICH FOR MEDICAID.

105


/

THIS HAS A DEBILITATING EFFECT NOT ONLY ON HEALTH, BUT

ALSO ON MORALE. THOSE AMERICANS IN POVERTY AND ON

WELFARE WHO ARE DETERMINED TO WORK THEIR WAY UP, RUN


THE RISK OF WORKING THEMSELVES OUT OF POVERTYINTO

MEDICAL INDIGENCE. AS THEIR INCOME RISES SLIGHTLY, THEY

EARN TOO LITTLE TO LIVE ON, BUT TO MUCH TO GET MEDICAID.

MEDICAID IS A MESS, AND IT IS BEGINNING TO COST LIVES,


RATHER THAN TO SAVE THEM.

106


INSURANCE COMPANIES HAVE RESPONDED TO THE CRISIS IN

NXXESCENT HEALTH, AND THE CRISIS IN HEALTHCARE IN
               5% M        &&I pcRbb$pf smuLP P

GENERAL, IN WAYS THAT       UNETHICAL, -ILLEGAL.

PREMIUMS SUDDENLY GO UP AS SOON AS MEDICAL BILLS COME

IN WITH ANY REGULARITY. OLDER ADOLESCENTS SUFFERING A

CHRONIC PROBLEM OR DISABILITY OFTEN FIND THEMSELVES

UNINSURABLE. AT AGE 22 THEY CAN FIND THEMSELVES

DROPPED FROM A PARENTAL POLICY --IF INDEED THEY WERE

EVER COVERED-- AND THEN, THANKS TO COMPUTER DATA

BANKS, THEY ARE BLACK-LISTED BY ALL INSURANCE

107


WE NEED TO MOUNT PUBLIC PRESSURE AND DIRECT

LEGISLATION TO IMPROVE PUBLIC AND PRIVATE INSURANCE.


OUR CURRENT SYSTEM OF HODGE-PODGE AND SHELL GAMES IS


A NATIONAL DISGRACE.

/ I'

ALL CHILDREN AND ADOLESCENTS SHOULD HAVE ACCESS TO


ADEQUATE HEALTH CARE INSURANCE. IT MUST COVER CHRONIC


CARE AND CARE IN THE COMMUNITY.      /

108


IT MUST RECOGNIZE THE COMPREHENSIVE NEEDS OF CHILDREN,

ADOLESCENTS, AND THEIR FAMILIES.

IT MUST ASSURE EQUAL ACCESS TO CARE FOR ALL


ADOLESCENTS ACROSS GEOGRAPHIC BOUNDARIES.

ABOVE ALL, INSURANCE COVERAGE MUST BE BROADENED TO

INCLUDE PREVENTIVE PROGRAMS. THAT SAVES MONEY AS WELL


AS LIVES.

109


FINANCING NEEDS TO BE CREATIVE TO ALLOW COLLABORATION

BETWEEN THE VARIOUS PROGRAMS AND PERSONS DEALING


WITH ADOLESCENT HEALTH.

THE COLD ECONOMIC REALITY IS SIMPLY THIS. IT IS A GOOD


INVESTMENT TO SPEND SOME MONEY --BOTH PUBLIC FUNDING


AND UNIVERSALLY AVAILABLE AND AFFORDABLE PRIVATE


INSURANCE-- RATHER THAN MORE MONEY LATER.

110


DOLLARS SPENT FOR HEALTHY CHILDREN AND ADOLESCENTS

WILL SAVE DOLLARS SPENT ON COSTLY ADULT HEALTH CARE


LATER.

IT IS GOOD COMMON SENSE AND GOOD BUSINESS SENSE TO

RAISE A HEALTHY YOUNGER GENERATION, BUT IT HAS NOT BEEN

GOOD POLITICS.

YOUNG PEOPLE SUFFER FROM GOVERNMENT INATTENTION

BECAUSE THEY DON'T VOTE, AND THEY HAVE NO LOBBY TO

REPRESENT THEIR INTERESTS. SO GOVERNMENT HAS PROVEN

RELUCTANT TO SPEND FOR THE HEALTH OF CHILDREN AND

ADOLESCENTS, EVEN THOUGH THE LONG TERM BENEFITS AND

SAVINGS OUTWEIGH THE IMMEDIATE SHORT TERM


EXPENDITURES.

111


WE NEED TO CHANGE THAT SHORT SIGHTED THINKING.

WE MIGHT LEARN AT LEAST A LITTLE SOMETHING FROM RECENT

BOONDOGGLES LIKE THE S&L CRISIS, THAT CONFRONTING A

PROBLEM EARLY CAN AVOID BIGGER AND MORE COSTLY


PROBLEMS LATER ON.

112


I FEAR THAT THE ADMINISTRATION AND CONGRESS WILL NOT

ADDRESS THE ISSUE OF ADOLESCENT HEALTH ON THE CLEAR

MERITS OF THE SITUATION --IN SPITE OF THE NATION'S


AFFLUENCE AND PROSPERITY. THE DAY WILL COME WHEN THE

BUSINESS COMMUNITY WILL EXERT GREATER PRESSURE FOR

MORE REALISTIC FUNDING OF HEALTH CARE. WE MUST MAKE

SURE THAT ADOLESCENTS ARE NOT LEFT OUT.

113


FORTUNATELY SOME INDIVIDUALS AND CORPORATIONS, NOT

JUST HUMAN SERVICE ORGANIZATIONS, ARE SEEING THE


COMPELLING NEED TO INVEST IN THE HEALTH OF OUR CHILDREN

AND ADOLESCENTS, . ..AN INVESTMENT IN THEIR HEALTH, NOT

JUST IN THE TREATMENT OF DISEASE.

WE NEED MAJOR CHANGES IN THINGS THAT ARE HARD TO

CHANGE: SOCIAL INSTITUTIONS AND PROFESSIONAL PRACTICES.

114


THE TASK BEFORE US IS DIFFICULT.

BUT SO ARE MANY OF THE TASKS DISCUSSED IN LECTURES

BEFORE THIS DISTINGUISHED AUDIENCE.,


WE ARE HERE BECAUSE WE ARE CONCERNED.


WE ARE HERE BECAUSE WE BELIEVE IN THE ABILITY TO

TRANSLATE THE BEST OF THE SPIRIT OF MAN INTO ACTION, INTO


CHANGE.

115


LIFE AFFORDS NO GREATER RESPONSIBILITY, NO GREATER

PRIVILEGE THAN THE RAISING OF THE NEXT GENERATION.

TO BE TRUE TO THE SPIRIT OF THE SPIRIT OF MAN, I CALL UPON

YOU, UPON US ALL TO MAKE A FOCUSED COMMITMENT TO MEET

THE HEALTH NEEDS OF THIS NEGLECTED SEGMENT OF OUR

SOCIETY, OUR ADOLESCENTS.

116


NOW, THERE IS ONE MORE POINT I SHOULD MAKE IF WE ARE
/

GOING TO BE HONEST WITH OURSELVES IN DEALING WITH THESE

PROBLEMS OF ADOLESCENT HEALTH.. . . . IF WE ARE GOING TO

DEAL WITH THESE PROBLEMS, NOT IN A THEORETICAL OR
          I$3

RHETORICAL WAY, PUT IN A DOWN-TO-EARTH, PRACTICAL, AND

PERSONAL WAY.

THE ISSUE SIMPLY STATED IS THIS:

ADOLESCENTS ARE NOT THE EASIEST PEOPLE TO DEAL WITH.

117


MANY ADULT AMERICANS ARE SIMPLY NOT DRAWN TO

AWKWARD, ABUSIVE ADOLESCENTS. THEIR ATTITUDES AND

BEHAVIOR CAN PUT OTHER PEOPLE OFF. AND, IN SPITE OF THE

POWER OF PEER PRESSURE, ADOLESCENTS OFTEN DON'T

ADMIRE EACH OTHER. THEY FIND FEW ROLE MODELS AMONG

THEMSELVES. AND THE ONES THEY DO FIND OFTEN LEAD THEM

DOWN THE WRONG PATH.

BUT THE PICTURE NEED NOT BE SO BLEAK. THERE ARE MANY

HEROS AMONG OUR ADOLESCENT POPULATION. IT'S TIME WE

GAVE THEM THEIR DUE, IT'S TIME WE LET THEM DO WHAT THEY

CAN DO AS ROLE MODELS FOR OTHER ADOLESCENTS.

118


TWO OF MY GREATEST HEROS, PEOPLE OF REAL INSPIRATION


ARE ADOLESCENTS. THEY CARRY ALL THE EMOTIONAL BURDENS

NORMAL TO ADOLESCENTS, BUT THESE TWO FELLOWS CARRY

MORE, MORE THAN I COULD BEAR.

PAUL AND CHRISTOPHER HAVE BEEN AN INSPIRATION TO ME,

AND TO COUNTLESS OTHERS, ADULTS, ADOLESCENTS, AND


CHILDREN. PAUL AND CHRISTOPHER HAVE LIVED ALL THEIR


LIVES WITH PROBLEMS THAT WE "NORMAL" PEOPLE LABEL AS "


DISABILITIES."

119


BUT THEIR DETERMINATION, THEIR RESILIENCE, THEIR


POSSESSION OF THE BEST OF THE SPIRIT OF MAN MADE ME ASK


MANY TIMES

"WHO ARE THE TRULY DISABLED AMONG US?"

THERE WERE w39 MANY TIMES DURING MY CAREER AS A

PEDIATRIC SURGEON, WHEN I HAD TO PUT ASIDE MUCH OF THAT


EXPERIENCE AND THAT RHETORIC -- WHAT MIGHT BE CALLED

THE "CONVENTIONAL WISDOM" OF DISABILITY.

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PAUL CERTAINLY MADE ME DO THIS. NOT LONG AGO PAUL

GRADUATED FROM HIGH SCHOOL,               HE


FINISHED WITH A VERY GOOD ACADEMIC RECORD...HE WAS ALSO

ON THE VARSITY BASKETBALL TEAM. AND HE WAS CLASS

VALEDICTORIAN. A RATHER GOOD RECORD, I WOULD SAY.

BUT I THINK THE "CONVENTIONAL WISDOM" OF DISABILITY

WOULD PROBABLY HAVE WRITTEN PAUL OFF MANY YEARS AGO.

PAUL IS A GRADUATE NOT ONLY OF SECONDARY SCHOOL -- BUT
42

OF~~OPERATIONS, EACH OF THEM DIFFICULT, EACH OF THEM

NECESSARY, EACH OF THEM A TERRIBLE, TRAUMATIC

INTERRUPTION IN THE LIFE OF A GROWING BOY.

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I KNOW ABOUT THESE OPERATIONS BECAUSE I PERFORMED 37

OF THEM.

BUT PAUL SURVIVED THEM ALL -- AND THE GROWING PAINS OF

ADOLESCENCE, TOO -- AND TODAY HE IS A STRONG, DECENT,
BRIGHT YOUNG MAN, A- f&w 86 F GRhRu4T '  ,*ed /dJ--
pp&l#&l &- fp%-omvJ1/34 F -JO f3*

I'LL MAKE A CONFESSION RIGHT HERE AND ADMIT THAT I DON'T

REALLY KNOW HOW HE DOES IT. BUT THROUGH THE YEARS HE

HAS ABSORBED THE SHOCK OF REPEATED OPERATIONS.

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HE HAS ABSORBED THE HIGHS OF LOVING, TENDER CARE AND

THE LOWS OF REJECTION.

YEAR AFTER YEAR HE HAS HAD TO ABSORB A GREAT DEAL OF

INFORMATION ABOUT HOW TO GO ON LIVING DURING THE


MASSIVE RECONSTRUCTIONS BEING DONE TO HIS FACE AND HIS


BODY.

WE WOULD CALL HIM A "DISABLED, HANDICAPPED" CHILD. BUT

PAUL...SO COURAGEOUS AND SO VERY INNOCENT... HAS REFUSED

TO BE DISABLED AND HANDICAPPED. AND SO HE HAS ENDED

THIS CHAOTIC AND PAINFULLY LONG PERIOD OF CHILDHOOD,

PUBERTY, AND ADOLESCENCE AS AN IMPORTANT YOUNG MAN.

123


1 COULD NOT HAVE DONE IT. I KNOW VERY FEW PEOPLE WHO

COULD. I THINK MOST OF & ARE TOO "DISABLED" IN FAITH OR

IN SPIRIT OR IN COURAGE TO HAVE GONE THROUGH SUCH AN

ORDEAL OF PHYSICAL AND EMOTIONAL RECONSTRUCTION.

NO, THE ONLY PERSON WHO COULD HAVE SUCCESSFULLY

WEATHERED THE YEARS OF REPEATED SURGICAL ASSAULT IS, OF

COURSE...PAUL HIMSELF. j-lJ HAS THE ABILITY. AND I AM VERY,

VERY PROUD TO CALL HIM MY FRIEND.

124


BUT LET ME ADD JUST A WORD ABOUT HIS FAMILY.

SOME YEARS AGO, WHEN PAUL WAS ABOUT TWO-THIRDS THE

WAY THROUGH HIS LONG SURGICAL ORDEAL, I WAS ASKED BY A


CANADIAN UNIVERSITY TO DELIVER A LECTURE ON A TOPIC


RELATED TO PAUL'S EXPERIENCE. I APPROACHED PAUL'S

MOTHER AND ASKED HER FOR ANY OBSERVATIONS SHE MIGHT

WANT TO MAKE. FOR EXAMPLE, I ASKED HER, "WHAT WAS THE


WORST THING THAT HAS EVER HAPPENED TO YOU IN YOUR

LIFE?"

125



AND SHE ANSWERED, "HAVING OUR SON BORN WITH ALL THOSE

DEFECTS THAT REQUIRED 37 OPERATIONS TO CORRECT."

I WASN'T SURPRISED BY HER ANSWER. BUT I ALSO KNEW SHE

HAD A STRONG FAMILY, A DEVOTED HUSBAND, AND THREE

OTHER CHILDREN WHO WERE BORN HEALTHY AND HAVE BEEN

LOVING SIBLINGS TO HER SON. SO I ASKED HER, "ALL RIGHT,

WHAT WAS THE BEST THING THAT EVER HAPPENED IN YOUR


LIFE?"

AND SHE ANSWERED, "HAVING OUR SON BORN WITH ALL THOSE

DEFECTS THAT REQUIRED 37 OPERATIONS TO CORRECT."

126


LET ME T&L YOU ANOTHER STORY ABOUT AN ADOLESCENT,

ANOTHER FORMER PATIENT OF MINE.

THIS ONE IS ABOUT A YOUNG MAN NAMED CHRISTOPHER. I MET

LITTLE CHRISTOPHER ABOUT 20 YEARS AGO WHEN HE WAS ONLY

4 DAYS OLD. AND HE WAS A MESS.

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   P /U/B JO Ice.- t &J7i+w ivc,7#--3$c ltv7F-F~ f@
HE HAD w. AND HE WAS A FLOPPY BABY. HE LOOKED

LIKE HE MIGHT BE MILDLY RETARDED. THREE OTHER

PHYSICIANS HAD DECIDED THAT CHRISTOPHER WOULD NOT BE

WORTH THE EFFORT AND THE COST OF REPARATIVE SURGERY.

AND THEY TOLD CHRISTOPHER'S MOTHER SOMETHING THAT

NOBODY CAN EVER PREDICT: THAT IS, THE KIND OF LIFE A CHILD

IS GOING TO HAVE.

128


CHRISTOPHER HAD A LEARNING DISABILITY. FROM THE VERY


BEGINNING, HE NEEDED A LOT OF HELP AND A LOT OF LOVE.


AND HE GOT BOTH.

CHRISTOPHER'S FAMILY HAD STARTED OUT PRETTY MUCH LIKE

MOST AMERICAN FAMILIES. REALLY, I THINK YOU CAN MEET


PEOPLE LIKE HIS MOTHER AND FATHER ALMOST EVERY DAY


ANYWHERE IN THIS COUNTRY.

BUT THEY HAVE A SPECIAL ADVANTAGE: THEY'VE HAD

CHRISTOPHER.

129


CHRISTOPHER HAS TAUGHT THEM A GREAT DEAL ABOUT LIFE.

AS A DISABLED CHILD, THEN AS A DISABLED ADOLESCENT HE

MADE THE REST OF HIS FAMILY...

ABLE TO CARE DEEPLY ABOUT EACH OTHER...

ABLE TO GIVE EACH OTHER GENUINE, UNABASHED LOVE AND

AFFECTION...

AND MADE THEM ABLE TO EXTRACT FROM THEIR OWN HEARTS

AND SPIRITS THE FINEST, PUREST INSTINCTS OF HUMANITY

130


CHRISTOPHER BROUGHT ABOUT AN EXTRAORDINARY CHANGE IN

THE LIFE OF THIS OTHERWISE ORDINARY FAMILY. HE HAD

ENRICHED IT SO, THAT HIS FAMILY MADE A MOMENTOUS


DECISION. THEY MOVED TO A LARGER HOUSE ON A FARM

OUTSIDE OF TOWN AND ADOPTED 12 MORE RETARDED CHILDREN.

THEY BROUGHT THOSE KIDS INTO A SNUG, LOVING HOME, WHERE

EVERYONE GROWS UP WITH A RATHER SPECIAL, RATHER


PRECIOUS ABILITY TO CARE VERY DEEPLY ABOUT THE PEOPLE


SITTING ON THEIR RIGHT AND THEIR LEFT.

131


WHEN CHRISTOPHER ENTERED ADOLESCENCE HE JOINED THE

BOY SCOUTS. HE TOLD ME ABOUT IT DURING A VISIT TO MY

OFFICE AT THE CHILDREN'S HOSPITAL OF PHILADELPHIA. HE

SAID THAT HE HAD A GREAT AMBITION. HE HOPED ONE DAY TO

BE AN EAGLE S.COUT.

YOU SEE, CHRISTOPHER DID NOT REALLY ACCEPT THE FACT


THAT HE WAS A DISABLED ADOLESCENT WITH LIMITATIONS ON


HIS PERSONAL LIFE AND AMBITIONS.

132


I SAID, "CHRISTOPHER, I'M TICKLED THAT YOU'VE JOINED THE

SCOUTS. AND I WANT YOU TO PROMISE TO TELL ME WHEN YOU

BECOME AN EAGLE SCOUT. I WANT TO BE THERE WHEN YOU GET


YOUR BADGE.

HE PROMISED HE WOULD TELL ME. AND HE DID

133


A FEW YEARS LATER I WENT FROM WASHINGTON TO  fl /J tfqf! dwrJ

-TO A LITTLE CEREMONY IN WHICH I PINNED THE

EAGLE SCOUT BADGE ON MY FRIEND CHRISTOPHER. HE STOOD

ON THE STAGE AND THANKED HIS PARENTS, HIS SCOUTMASTER,

HIS DOCTOR, HIS FIVE HEALTHY, NORMAL SISTERS, AND HIS 12

ADOPTIVE BROTHERS AND SISTERS. HE THANKED US ALL FOR


THE HELP AND ENCOURAGEMENT WE'D GIVEN HIM SO THAT HE


COULD ACHIEVE HIS AMBITION OF BEING AN EAGLE SCOUT. I


THOUGHT WE ALL SHOULD HAVE THANKED HIM.

134


CHRISTOPHER WAS A TEXTBOOK EXAMPLE OF A "DISABLED,

HANDICAPPEP" ADOLESCENT. OF COURSE, IT'S OUR

TEXTBOOK...NOT HIS. AND THANK GOODNESS FOR THE


DIFFERENCE.

THESE TWO YOUNG PEOPLE -- PAUL AND CHRISTOPHER -- ARE

JUST TWO OF A LARGE NUMBER OF DISABLED CHILDREN AND

ADOLESCENTS THAT I'VE HAD THE PRIVILEGE TO KNOW AND TO

HELP DURING MY PROFESSIONAL LIFE IN MEDICINE.

135


THEY ARE ALL VERY SPECIAL PEOPLE TO ME. THEY WERE ALL


BROUGHT TO ME BECAUSE THEY WERE IN SOME WAY HURT OR

DAMAGED OR INCOMPLETE. THEY WERE, IN THE EYES OF

MEDICINE AND SOCIETY, TOO,


DISABLED...HANDICAPPED...lMPERFECT...DlFFlCULT... THE SAME


TERMS SEEM TO BE APPLIED BY SOCIETY AT ONE TIME OR

ANOTHER TO ALL ADOLESCENTS.

136


BUT I'VE LEARNED IMPORTANT THINGS FROM EVERY ONE OF

THEM. AND I'VE HAD TO ASK MYSELF, "JUST HOW COMPLETE

AND ABLE AND PERFECT AM I, IF THEY CAN TEACH ME SO MUCH

ABOUT THE WONDER OF LIFE?" AND THE ANSWER IS QUITE

HUMBLING, WHICH IS A REACTION NOT COMMONLY FOUND

AMONG SURGEONS.

137


NOW, THERE IS A DANGER IN ROMANTICIZING ILLNESS AND

DISABILITY. THAT'S NOT A HEALTHY THING TO DO. AND I HOPE


YOU DON'T THINK THE STORIES OF MY TWO YOUNG FRIENDS


WERE ROMANTIC OR FANCIFUL. THEY AREN'T. QUITE THE


OPPOSITE. THEY ARE VERY REAL YOUNG MEN.

THE WAY THESE ADOLESCENTS TRIUMPHED OVER

DISADVANTAGE AND DISABILITY MADE ME ASK AGAIN "WHICH

OF US IS DISABLED?"

138


IS IT T-HE YOUNG MAN WITH THE MUSCULAR DYSTROPHY WHO

RESOLUTELY NEG.OTIATES THE SCHOOL HALLWAYS AND STAIRS

SO AS NOT TO BE LATE FOR ANYTHING? OR IS IT THE THERAPIST

WHO SEES THAT YOUNG MAN ONLY AS A DISABLED VICTIM OF

THE DISEASE.

139


IS IT THE MILDLY RETARDED YOUNG WOMAN WHO IS IN

PERPETUAL MOTION, CONSTANTLY DOING A HUNDRED-AND-ONE

LITTLE CHORES FOR HER FAMILY AND FRIENDS. OR IS IT HER


TEACHER WHO METICULOUSLY CONCENTRATES ONLY ON A

HANDFUL OF BASIC SKILLS.

140


IS IT THE TEENAGER WITH IMPAIRED VISION, NEARLY BLIND, BUT

STRUGGLING TO LEARN PIANO? OR IS IT THE NEIGHBOR WHO

SAYS SHE CAN'T PUT UP WITH THE NOISE FOR ONE MORE DAY?

141


I SUPPOSE IT WOULD BE NICE TO BE ABLE TO SAY THAT I CAME
    ToOW

HERE B TO DELIVER A BRAND-NEW MESSAGE. BUT I

CAN MAKE NO SUCH CLAIM. MY MESSAGE IS REALLY VERY OLD.

THE TEXT IS FROM THE ETHICS OF ARISTOTLE, WHO MADE THIS

LITTLE OBSERVATION SOME 2400 YEARS AGO. I DON'T ALWAYS

AGREE WITH ARISTOTLE, BUT I'LL NEVER QUIBBLE ON THIS

OBSERVATION:
     /

   "THE NATURE 0~ MAN," *SAID, "1s NOT WHAT HE WAS
BORN y &3, BUT WHAT HE WAS BORN FOR."
  Y-l

142


AS MORE AND MORE OF OUR ADOLESCENTS ARE ALL TOO

READILY DISMISSED FOR WHAT THEY WERE BORN &, WE NEED

TO EMPLOY THE BEST OF THE HUMAN SPIRIT, BREATHED INTO US

BY GOD, TO SEE THAT THEY CAN BECOME ALL THAT THEY WERE


BORN FOR.

143