Tag Archives: mental health

Burden Sharing: A Mother’s Day Reflection, Dr. Robert Zuber

12 May

What we don’t need in the midst of struggle is shame for being human. Brené Brown

To heal is to touch with love that which we previously touched with fear. Stephen Levine

The trauma said, “Don’t write these poems.” My bones said, “Write the poems.”  Andrea Gibson

There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds. Laurell K. Hamilton

That was a long time ago, but it’s wrong what they say about the past, I’ve learned, about how you can bury it. Because the past claws its way out.  Khaled Hosseini

May your forgiveness still the hunger of the wound. John O’Donohue

The mistakes of the world are warning message for you.  Amit Kalantri

The wind will rise; we can only close the shutters.  Adrienne Rich

One of the highlights of my recent trip to South Africa was meeting Fr. Michael Lapsley, the founder of the Institute for Healing of Memories (www.healing-memories.org) a program which has resonated with communities from Durban to Detroit.  Fr. Lapsley has overcome his own trauma from violence inflicted during the transition from apartheid to a reasonably functional democracy.  He has turned his own affliction into ministry, helping mothers and others who carry great burdens through their lives to lay some of those burdens down, to swap out the toxic effects of trauma for healing and forgiveness, recovering some of the energy that their families and the world at large often require of them. 

This engagement with the Institute, which I hope will continue to develop, is the latest iteration of an organizational  priority to better balance policy and personal engagements which already includes work on Servant Leadership with Dr. Robert Thomas and on Inner Economy with Dr. Lisa Berkley.  While they differ somewhat in focus and intellectual underpinnings, all convey the truth that we have collectively struck an unholy alliance between policy and technology which largely bypasses dimensions of character, compassion and service which are essential attributes  of societies which refuse to give in to hatred, grievance and entitlement, which refuse to abandon the aspiration of a world in which humans and other manifestations of the created order can live in a better harmony, can nurture and celebrate the commons instead of seeking to control it, can cease the degrading march of green and public spaces into private ownership and exploitation.  

What does this have to do with Mother’s Day?  Several things I believe.

Amidst the annual panic to sign cards and buy grocery store flowers, amidst and annual blitz of commercial propaganda selling the aspiration of “all” women for the gift of diamonds and other jewelry, it is worth remembering that the person deemed most responsible for this annual faux tribute to mothers, Anna Jarvis, was so put off by the superficiality of the day – cards instead of conversations, diamonds instead of dialogue – that she petitioned to have the annual event which was designed to honor her own mother revoked.  But by that time, this latest in a sequence of transactional honoring had caught on. We had eagerly purchased another surface, created yet another opportunity to dive into a few hours of recognition which ought not to be calendar-induced nor satisfied by sparkling pieces of pressurized coal. 

Many of the mothers associated with programs such as Healing of Memories don’t have any reason to anticipate or welcome this annual bling.  They often bear the scars of a difficult and demanding  life, scars which many are determined to bear with dignity lest the children they seek to protect would have their own enthusiasm for life dampened by the struggles of their parents. These are some of  the mothers determined as they are able to “touch with love” even as the winds howl beyond the shutters and the mistakes of the world beat at their very doors. These are some of the mothers determined to live poetic lives even as hurts are deep and inspiration remains beyond reach.  These are some of the mothers for whom the storms all-too-rarely relent but who nevertheless accept the responsibility to quell the fear of those around them without exposing for family or public view the fear also raging inside themselves.

The three hopeful  program priorities of Healing of Memories – prevention, healing and empowerment – convey a complicated message for participating mothers, for all mothers really.   Yes, mothers know well of prevention, the injections that prevent childhood deaths, the clothes that buffer the hostile elements, the diets which help to guarantee proper physical development, the out-loud reading that paves the way for future learning.  But beyond the walls of domicile, there are threats of even greater consequence, threats from more sophisticated weapons and degraded agriculture, threats from the serendipity of climate disruptions and the hatred of humans given license to grow even more toxic.  These we must also do much more to prevent at the level of policy and governance if the prevention undertaken by mothers as mothers is truly to be honored.

And what of healing? Yes we can bind the scrapes of children as we are able.  And if we are fortunate enough we can enlist medical professionals to help ensure that the sicknesses of children don’t become chronic, even life threatening.  But children become physically and emotionally disabled. In some parts of the world they die in shocking, horrific numbers.  And in all parts of the world, children face disappointment, lonliness and heartache.  And they look to parents – to mothers – for succor and solace, for some modicum of healing from people who often struggle with their own wounds, their own pain, their own disappointment and heartache.  What a former teacher of mine, Henri Nouwen, referenced often (via Carl Jung) as “wounded healers” applies to many more of us, certainly many more mothers, than we generally acknowledge.

We must become clearer with ourselves about just how vulnerable a species we can be – how long the distance often is between the wounds we inflict and their healing.  We should also be clear about our collective creation of a world with many ways to inflict damage and fewer ways to heal what we have inflicted.  And so we must follow the inclinations of those mothers seeking to become more accomplished healers, to invite unburdening rather than trying (largely in vain) to seal off our wounds, trying to sequester them in those deep places away from public scrutiny or even consciousness itself, forgetting that the pain of children – much like our own — will eventually find the means to “claw its way out.”

Ultimately, we must find a more effective way to turn off the spickets of destruction and abuse that complicate and undermine healing in all its forms.  We must do more in our policy engagements to ensure broader spaces where the bombs no longer fall, the storms no longer rage, the relentless soiling of our own habitats is at least suspended, making spaces more conducive to healing, to reconciliation, even to empowering young people and others to face the strong winds and invest more of themselves in making a better life, not only a better living. We have learned much from mothers about how this is done, how they inspire more courageous, empowered and intentional living despite the “hungry wounds” they often experience in their own souls and bodies.

This burden sharing is what we strive to better achieve but also to better honor, this day and every day.

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Waiting Room: Ending the Global Frustration on Small Arms, Dr. Robert Zuber

1 Aug

I aimed at the public’s heart, and by accident I hit it in the stomach.  Upton Sinclair

I guess that’s what disappointment is- a sense of loss for something you never had.  Deb Caletti

To make someone wait: the constant prerogative of all power.  Roland Barthes

Life is a long preparation for something that never happens.  W.B. Yeats

He had the look of one who had drunk the cup of life and found a dead beetle at the bottom.  P.G. Wodehouse

Disappointment’ s cousin is Frustration, the second storm. Chetan Bhagat

Deep under our feet the Earth holds its molten breath, while the bones of countless generations watch us and wait.  Isaac Marion

I have a (bad) habit of indulging in what is known in the radio business as “sports-talk,” a phenomenon characterized by mostly men calling in to show hosts – also mostly men – and airing mostly grievances about things which, in the grand scheme of things mostly don’t matter.  In this media format, people lose their minds over such important things as how far someone can throw an American football, whether or not so-and-so has the “clutch gene,” or how some player can possibly “earn” a salary which might be, literally speaking, 1000 times larger than those of the callers.

But for all its stunning banality, sports-talk is also a window on culture, a culture which seems increasingly unhinged, where external grievance has almost completely obliterated internal gratitude; where we engage the outside world mostly to satisfy our rooting interests rather than to root out the fear and suspicion causing many of us to build walls rather than open doors, indulge emotions that might otherwise be considered unseemly, and utterly confuse the petty and the profound.

Some of this was on display this week regarding a decision by gymnast Simone Biles to forgo Olympic events she was expected to win due to concerns over her own mental stability and thus her ability to participate in jumps and twists and twirls with high potential for injury if your mind “isn’t right.”  While some radio callers were sympathetic, many others were in the “throw some dirt on it” and get back to business crowd, based on some underlying sense that Biles “owes” the rest of us a performance regardless of her mental state, regardless of the threats her high-wire acts actually pose to herself, and regardless of how many times she has honored her talents – and her audience – in the past.

It occurred to me that these are the kinds of comments we make when there is not enough of life washing over us, when the social isolation of the times breeds what we might expect it to – a suspicion of everything outside our bubbles save for the thing we do well to be most suspicious of in these precarious times – the bubbles in which we have immersed ourselves.  Yes, some of us may well have gotten a bit too “soft” in these times, giving up and giving in, pulling the bed covers over our heads when it is time to get up and face the world to the best of our current capacity.  But many of us have also lost a bit of speed on our metaphorical “fast balls,” a bit of confidence, a bit of judgment, a bit of energy, a bit of perspective, a bit of connection. Many of us are not even close to our mental-best now and, unlike Simone Biles, seem incapable of recognizing as much. Some would seemingly rather lose their proverbial lunches over mask wearing — the current societal equivalent of sports-talk grievances – as though a patch of blue material and two white strings constituted an existential threat to our well-being, as though our “freedom” to consume our metaphorical meals as we alone wish also includes the “freedom” to stick a fork in the stomachs of others.

As the United Nations also recognizes, we are collectively facing a mental health crisis which mirrors and is directly affected by our pandemic-related physical health threats.  Over the past 18 months the losses have been both numerous and challenging to chronicle – people losing their homes and plunging into poverty; people facing grave food insecurity and social isolation; people having to make decisions they thought they would never have to make as incomes evaporate, schools close and threats from armed violence, traffickers, political instability and climate change leave millions in situations beyond precarious.  For too many in our world, the pandemic has done more than merely interrupt our personal goals and aspirations but is more akin to “piling on,” heaping trauma on top of deprivation and fraying a social fabric which represents a mortal loss to people less and less able to meet their own basic needs.  

It is hard even to imagine the mental strains associated with this confluence of grave challenges, but to some degree, this is the business of those of us who work in multilateral policy settings. We are mandated to identify at least some of the pain and to ensure that at least some of our policy work is germane to its easing, is at least adequate to those waiting for the relief and restoration that they are unable to effect for themselves.  This week, the UN reflected on those languishing in COVID-infected prisons in Syria, those daring to take to the streets in Myanmar seeking to pry governance from the bloodied hands of the military junta, those in Tigray and Yemen waiting desperately and relentlessly for provisions which have become tactical elements in a larger conflict.  These are just some of the people whom we have encouraged to assume that we have their back, that we have some of what is needed to free them from suffering and help restore them to health, including and especially mental health, health which they will need if they and their loved ones are to navigate a world with high threat levels beyond the immediate levers of misery.

But exposing mental health deficiencies and calling for more “services” is only part of the equation.  At  UN events this week focused on victims of food insecurity and human trafficking, speakers from the UN and from field-based NGOs noted the urgent need for victims to be “seen beyond their trauma,” to be regarded as agents of change and healing and not only recipients of assistance, to underscore the strong desire of many to be “the last victim” of exploitation and deprivation, and thus to be the forefront of efforts to move people to places of self-sufficiency and dignity, aspects long-denied people seeking (and sometimes failing) to outrun the “storms” that seem forever to form on the horizon.

The power of victim testimony was evident this week, insisting on a place at the policy table, noting how much easier it is to “walk strange roads” towards health and recovery alongside others who have walked them previously, affirming with actress Mira Sorvino that the ” bravery and lived experience” of survivors can be amplified and thus help to inspire the international community to do more to prevent and restore what Sorvino referred to as “decimated lives.”  Others, including at the UN Food Systems pre-Summit underscored the urgency of the times, the “children who face starvation while we sit here and make speeches,” our half-measures that too-often reinforce the trauma from the long waiting we have, at some core level, pledged to reduce.

Such half-measures also punctuated what was one of the signature events of the UN week, the 7th Biennial Meeting of States on Small Arms and Light Weapons, a meeting intended to push forward implementation of the Programme of Action (PoA) to combat illicit weapons and prevent their diversion from authorized to unauthorized sectors.

Like other aspects of our collective work, this PoA while not legally binding nevertheless constitutes a promise to communities awash in weapons illicit and otherwise, weapons which intimidate and coerce, weapons which undermine development progress and effective parenting, weapons which in the hands of the stable and (increasingly) unstable cause deaths for some and enable other abuses much easier to commit at the point of a gun.

As I often do, I wondered while watching some of this PoA unfold, how this scene might appear to those in diverse communities begging for relief from armed violence threats, waiting and waiting some more for the solutions that they cannot effect by themselves, wondering if it is the lot of their children to spend their lives dodging bullets and the intimidation of armed bullies, wondering also if those seeming to place national interest before human interest will ever understand the relationship between the global saturations of weapons and the trauma those weapons engender and which are routinely experienced by millions.

There were some excellent proposals put forward by Costa Rica, South Africa, Colombia and others regarding the need to expand the scope of the PoA to include ammunition (the “bullets that kill”), to affirm closer synergies with the Arms Trade Treaty and other international instruments, to affirm that the PoA is related at its core to implementation of the Sustainable Development Goals, to fully integrate women’s participation and victim-centered perspectives into this work, and most importantly, to reinforce the view that reducing production of weapons is the most direct path to ending the diversion of weapons; that the more weapons in circulation the harder they are to manage. 

All of these proposals seemed worthwhile to us, in fact seemed indispensable to fully meeting the promises embedded in the PoA.  And yet resistance to each was considerable, at times fierce, perhaps even borderline irrational from the perspective of those who seek to honor those waiting and waiting for evidence of a reawakened sanity on arms proliferation. Demands to uphold “consensus” rained down on the PoA conference room, claims often made by states with only tepid interest in abiding by the actions which the prevailing BMS consensus had already advocated. This was hardly the “right signal” to the world which Mexico hoped to send, certainly not to those frustrated hearts we are trying to convince regarding our commitment to understand and scale back the growing small arms threat.

Perhaps no reaction to this resistance was as poignant as that of the PoA Chair, Ambassador Kimani of Kenya.  In his closing remarks, he vetted his “learning” from this often-contentious week challenging the value and viability of prevailing notions of consensus and coming to a fresh if disquieting understanding of the frustration of global communities regarding the UN’s alleged ability to “solve their problems.”

He could also have wondered, if he dared, if our global institutions were now destined to magnify trauma and other threats to mental and physical health rather than mitigate them, if we have become hard-wired to use the power at our disposal to force other people to wait – even unto death — until we get our act together, until we recover our full policy sanity, until we recognize who we actually work for and what they now require of us. The victims of gun violence – like those of trafficking, famine and a deadly pandemic –need us to heed their voices and honor their efficacy, need us to walk with them down unfamiliar paths and refuse to contribute to yet more disappointment or loss; but also to do the jobs we’ve been entrusted with, to restore credibility jeopardized or even lost among those who find themselves in situations where there is simply no more time to wait.  

Our still-declining mental health requires increased services and the policy participation of the traumatized; but it also requires safer and more predictable environments in which to feed, educate and raise our children.  A world awash in weapons simply cannot ensure such settings.  We who profess to care about those persons waiting for weapons-related relief simply must find the means to provide it.

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Wobble World: Calming our Personal and Planetary Shaking, Dr. Robert Zuber

25 Apr
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Wake up. If your eyes are sleeping then wipe them gently. You need to be awake for this. It is a matter of life and death.  Kamand Kojouri

Longer than an earthquake, a pandemic shakes your life and living. P.S. Jagadeesh Kumar

There is nothing stable in the world; uproar’s your only music.  John Keats

On what slender threads do life and fortune hang!  Alexandre Dumas

As anywhere else, political instability provided an opportunity for local scores to be settled, for personal grievances to be aired, for heroes to be acclaimed and discarded.  Charles Emmerson

Instead of a stable truth, I choose unstable possibilities. Haruki Murakami

Humans can’t be strong because of the comfort & can’t be comfortable because of instability.  Sonal Takalkar

April is my favorite month of the year.  The gentle rains.  The longer sunlit days. The moderating temperatures.  The lightening of human moods, even in the midst of a pandemic that has lasted longer than most could have predicted or imagined, at least the moods of those of us privileged by health care access and vaccinations in a world still waiting – and waiting some more – for its fair turn.

And of course the trees and flower beds bursting with color.  In the north, April is the month that reminds us city dwellers of nature’s capacity – assisted in many instances by some truly remarkable urban gardeners – to regenerate itself and thereby tweaking the human race regarding the need for its own regeneration, its own need to recalibrate its relationship to the rest of the natural world, to (as UN SG Guterres says) “stop our war on nature.”

All this “Earth Week,” amidst a bevy of UN meetings alternately hopeful and maddening, I have been taking multiple, daily walks through nearby daffodil hillsides and under cherry blossoms and tulip trees.  I’ve also been spending evenings binge watching (for me) the stunningly filmed BBC nature programs hosted by the indefatigable David Attenborough.  I can’t get enough of either, not this week, not this month.

But all the color and the natural drama, the beautifully manicured parks and other scenes of a natural world bursting with new life also come attached to a blinking warning light, a warning that the flowers and species that make our hearts race are now under siege.  The biological rhythms that keep life in balance, indeed that help keep potential pandemics in check and our agriculture functional, are increasingly out of whack.  As our lands dry and our seas warm, species from bees to whales must find alternate survival settings on a planet increasingly hostile to their interests.

This “uproar” in the natural order, largely a consequence of human activity, is increasingly hostile to our own survival as well.  Those of us who are trying to stay vigilant, trying to stay awake and focused on our increasingly wobbly planet, seem so often to possess in our persuasive arsenal more warnings than we have solutions.  We know that deforestation ruptures food chains, destroys biodiversity and increases the likelihood of future pandemics at a moment when we have barely regained any firm footing from the current one. We know that our collective food security is regularly undermined through conditions from drought and flooding to soil erosion and the absence of pollinators. We know that levels of ocean plastics threaten to contaminate sea harvests on which many of the world’s peoples depend.

And we know that a warming planet continues to release both abundant methane into our atmosphere and vast quantities of precious fresh water into our oceans, altering both temperature and pH. In addition, a recent article by Brian Kahn chronicles the growing evidence that a combination of ice cap melting and groundwater depletion is causing a “wobble” in the very stability of our planet, a shifting (subtle for now) in the movements of the “rotational poles,” shifts in gravitational pull related largely to rapidly rising sea levels.

As the world wobbles on in response to our carbon addictive warming, so too do many of our fellow humans.  As noted at the UN this week, the current pandemic has been a boon to garden-variety narcissism but also to criminality in diverse forms – trafficking in persons and weapons, violence against cultural minorities, even the consolidation and expansion of extremist movements.   As the representative of the Maldives reminded this week during a UN General Assembly event on “urban crime,” cultivating a “sense of belonging” remains key to effective crime prevention. In its absence, criminal elements can establish (and have established) an increasingly malevolent, destabilizing presence, widening social divides and increasing levels of insecurity and anxiety within and across populations.

Such a “sense of belonging” has certainly been hard for us to come by during this pandemic.  So many of us, even the vaccinated and otherwise privileged among us, even those of us who have not been victimized by crime or lost those we love to a creeping virus, even we are now less stable, more wobbly, than we might otherwise admit.  Many of us have retreated to places that offer more comfort than growth; many of us have recalibrated relationships and passions and made the decision to shrink our circles rather than pushing them outwards; many of us have abandoned the goals and gifts that once animated our lives and provided hope for others as we “ride out this storm” that never seems to run out of destructive consequences.  We have at times allowed the insecurities in our immediate spaces rob our attentiveness to the almost unimaginable insecurities of others bereft of health care, bereft of security from traffickers and other criminal elements; bereft of food security as once viable croplands turn into non-productive deserts. 

And yet, despite our efforts to protect ourselves and those closest to us, it is not at all clear that we have put the threat from wobbles to rest. As the pandemic evolves and as our long social isolation and chronic uncertainty slowly begin to lift, many of us find that some aspects of our competence, our confidence, even our essential sanity, have taken a hit. 

As the buds and flowers of April spring open, they communicate what should be a hopeful signal to the rest of us:  If they can open to the world, so can we.  If they can spread their color, sharing the best of what they have to offer to brighten our sometimes dismal, lonely spaces, we can do the same for others.  If they can honor their annual biological commitments despite the wobbles of pollution, temperature and pollination, we can overcome our own struggles; indeed we can address the anxiety and even depression that will otherwise continue to impede our engagement with a human-saturated world that needs our sustainable caregiving input as much as it ever has.

Perhaps the signature event of this past week available on UN Web TV was actually not a UN event at all, but a Climate Summit convened by the US White House, bringing a range of global leaders together (virtually) to strengthen commitments to stem the steady march of a warming, species-threatened, plastics-inundated planet.  Despite a stream of largely predictable statements long on concern and short on change; and despite the opening warnings of UN SG Guterres that we are now risking a “mountain of debt on a broken planet,” there were a few genuine bright spots.  US VP Harris opened the Summit with surprising references to the “indigenous insight” and “nature-based solutions” that offer a tangible path forward, much of which was reinforced this week at the UN’s Permanent Forum on Indigenous Issues. Later on, the president of the Marshall Islands, stressed the need for his oft-vulnerable people to find “safe harbor” amidst the current tempest, noting that the safest of all would be policies and actions to keep global temperature rise at or below 1.5 degrees C.  He also noted the importance, as did other leaders, of using this “rare chance” provided by pandemic recovery to “to reset our economies and societies.” Perhaps reset ourselves as well.

All of this was helpful and hopeful, but as German Chancellor Merkel intoned, we face a “herculean” task requiring a thorough revision of the ways in which we now do our business.  Indeed, her statement raised questions, for me at least, about the sufficiency of our institutions, the wisdom of our policies, but even more about the resilience of our collective psychology, our ability to shed our pandemic cocoons, to find ways to stop our shaking and steady our wobbling, to do our best to overcome the anxieties and insecurities which have taken root during our long hibernation, to lay aside grievances born of social isolation and chronic instability and remain awake to a world which has been waiting anxiously for us to take up, once again, our engaged and caring roles, providing inspiration for healing that other people need and that might not exist if we don’t find the courage and capacity to share such ourselves.

As our world wobbles on, as we struggle to recover our economic and emotional health, the tasks lying before us seem to be growing in intensity not shrinking.  Of all these current “herculean” matters, perhaps the most daunting relates to recovering our own strength to overcome the after-effects of a most difficult time and play our role in this “life or death” moment for our world, embracing possibilities that might appear uncertain on the surface while making space for a wider and healthier range of global constituents to enter the conversation and share their own revision strategies.

The clear, consistent messaging coming from this UN week is that “we are running out of time” to change the way we do our business, to ensure that there will be more flowers and buds in springtime, more species able to dodge extinction, more people freed from pandemic anxieties and access inequities that continue to take such a heavy toll. We are running out of time to stabilize our now-wobbly planet and we urgently need to enable and support more of us still-shaken humans to remain awake to that task.

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Health Bar:  Ensuring Vitality for Sustainable Development, Dr. Robert Zuber

8 Jul

dayoffriendship

We are healthy only to the extent that our ideas are humane.  Kurt Vonnegut

Healing is impossible in loneliness; it is the opposite of loneliness. Wendell Berry

A sign of health is that we don’t become undone by fear and trembling, but we take it as a message that it’s time to stop struggling and look directly at what’s threatening us. Pema Chödrön

What drains your spirit drains your body. What fuels your spirit fuels your body. Caroline Myss

One of the things that we have noticed (with gratitude) over this past year about the UN policy agenda is the emphasis on health—not only on leveling access to health care but on indicators and implications of health for both our sustainable development and peace and security responsibilities.

As the ECOSOC High Level Political Forum prepares to convene on Monday, governments and NGOs will convene in large numbers from all directions to review progress on some of the most important Sustainable Development Goals (SDGs) – from clean water access and sustainable energy to reversing desertification and biodiversity loss, and sustainable production and consumption.  Through plenary reviews of national SDG progress and a remarkable series of policy-focused side events, the HLPF will provide the opportunity for all of us to assess the degree to which what is arguably the most comprehensive and urgent promise the UN has ever made to future generations is being properly honored.

Recent weeks have seen UN discussions on a range of health-implicated policies, from efforts to end tuberculosis to the expanding global crisis of access to safe drinking water in an era characterized by both diminishing supply and growing privatization. In the past few days alone, the UN has seen interesting events and negotiations focused on universalized health care, the role of “cooperatives” in increasing healthy food security, and an “interactive hearing” on Thursday in preparation for the third High-Level Meeting of the General Assembly on Non-Communicable Diseases.

At first glance the “non-communicable” disease focus might seem a bit trivial stacked up against Ebola, tuberculosis and a host of other pandemics – potential and actual – made more frightening by the increasing inefficacy of our antibiotics.  But we know that there are numerous and deadly health threats that we don’t “catch” from others but which we routinely impose on ourselves and our neighbors – the diabetes tied in large measure to our processed diets and immobility; the toxic substances that collect in women’s mammary glands and create breast cancer emergencies; the impediments to clean water access in our “privatizing planet” that sicken and suppress children and their caregivers; the substance addictions that ruin relationships and drain the spirit of resolve.  The environmental burdens we impose in the name of “progress,” the “lifestyle” choices we make in what are often futile efforts to overcome fear, anxiety and isolation – this and more has led increasingly to the ironic circumstance of longer lives characterized by only episodic vitality and enthusiasm for living.

Indeed, one of the takeaways from the interactive hearing was the degree to which “health” in our time is largely a matter of overcoming our battered spirit, our psyches filled with anxiety and remorse, our political climates of recrimination and repression, our propensity for inflicting violence that solves few problems but ensures lasting distress.  We are living through a moment where our already besieged spirits are under fresh assault.  And few medical professionals are now prepared to deny the impact that our collectively impaired mental health is having on our physical vigor.  Those seemingly growing numbers (including of our children) who suffer from depression or trauma are less likely to practically cherish their physical well-being.  Where the web of health is damaged, all aspects of vitality seem to be called into question.

Another of the many take-aways from the hearing had to do with the role of health professionals and private sector entities tasked with providing what we ostensibly require to overcome health threats – the doctors and nurses who bind wounds and diagnose deeper sickness, and the pharmaceuticals that provide us with the chemicals we need to overcome (but not necessarily prevent) health impediments.  As one might predict, there was considerable and sometimes heated discussion about the imprecise and shifting lines connecting regulation and innovation, connecting the need for companies to turn a profit and the needs of communities for life-saving generics, connecting  investments in high-tech therapies with (more human-effective) investments in prevention.   And of course the lines connecting the need for “evidence-based” health commitments with the fact that, as more than one expert noted, the available evidence in some instances is pointing in diverse directions.

There are clearly some trust issues to overcome amidst all of this uncertain balancing.  In one of the sessions, a professor from Rwanda challenged the sometimes facile articulation within and beyond the UN of the “public-private partnership model,” noting that while better “quality control” over agricultural and pharmaceutical production is important, the current preoccupation in some quarters with diets and other “lifestyle” issues is likely an over-reach. Such a preoccupation, she noted, tends to just “put the blame on the people.”  What she called for in addition was a greater commitment to transparency and broad public participation regarding government health policy, to lift the veil on the mostly off-camera “public-private” dealings that can saddle communities with medicines they don’t particularly need at prices they can’t afford.

If “leaving no one behind” is to be something more than the tag line for this HLPF, we must consider what keeps us vital in these challenging times, what make us not only able to benefit from sustainable development but allows us to participate fully and energetically in building a more sustainable world.  In this second and critical dimension of SDG implementation, the role of good health cannot be over-stated.  It is truly one of the blessings of life to be able to early rise from sleep and feel healthy enough to help take on some of the world’s problems, perhaps even ease a few burdens for others.  If the SDGs are to achieve their full promise (and there is really no planetary alternative to doing so), the vitality of the world’s peoples – our personal connectivity, “humane ideas,” uncontaminated environments and other indicators of well-being — must be better assured.

Health is a core dimension of sustainable development that the UN seems well-suited to address, and we strongly encourage its continued focus.  In its absence, woes of body and mind will continue to sideline too many of the skills, passions, ideas and connections needed to ensure a more peaceful and sustainable future.

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A Discouraging Word:Violence and its Multiple Impacts, Dr. Robert Zuber

11 Sep

The only shameful thing about mental illness is the stigma attached to it. — Lindsay Holmes

Last evening, on my way to a birthday party, I stopped by the World Trade Center site.  The powerful “9/11” spotlights were turned on, helicopters circled the area, and many loud banging noises could be heard in the neighborhood. While watching the spectacle, I had striking flashbacks of people jumping out of windows of the old Twin Towers because staying put on melting upper floors had ceased to be an option; also of responders urgently rushing up stairways that ultimately became their graveyards.

But I also thought about the thousands upon thousands of bombs that have fallen since “9/11,” the uncounted masses whose homes and shops will never be rebuilt, whose losses will never be formally commemorated; countless families who have barely known a moment of stability or peace for the past 15 years.

We in the US have been victims; we have created many as well. Violence in too many forms preceded 9/11 and violence in too many forms has defined its wake.

Such diverse forms and manifestations of violence always find a place on the agenda of the UN community: even when we fail to guarantee refugees safe passage; even when efforts to eliminate nuclear tests go up in flames; even when conflicts rage like wildfires that have long-since jumped the control line; even when abuses are committed against civilians by their erstwhile protectors; even when hospitals are bombed with weapons sold by countries that had previously pledged seller’s restraint.

There were many UN events this past week with implications for peace and security, for societies that no longer have to calibrate the staggering costs of violence (including their deep emotional wounds) that threaten every hopeful impulse.  Two for us stood out.

On Tuesday, the General Assembly help what is now an annual debate on the Responsibility to Protect norm for addressing genocide and other atrocity violence, placed on the UN’s agenda at the 2005 World Summit. “R2P” as it is known has attracted significant interest from many UN member states as well as from a handful of “loyalist” NGOs who were well represented at the debate, what one person described (with a hint of irony) as something akin to a “family reunion.”

Despite high regard for the norm and for addressing what Bolivia referred to as the “repugnant” crimes to which the norm points, this discussion brought many fault lines to the fore, based in part on the recognition (as described by Slovenia and others) that 11 years on from the World Summit the world is still facing widespread misery and displacement instigated by state and non-state actors.  The questions (and frustrations) were evident throughout. Brazil wondered about our habitual response to coercive responses that endanger the very persons we are trying to help.   Vanuatu wondered why states sit idly by waiting for the Security Council to act when there is much conflict prevention that even small states can promote.  Spain wondered why the UN’s promises of a “culture of prevention” remain essentially unfulfilled.

And yet amidst the frustrations, there were signs of positive life. Several states (and USG Dieng) called (as we have also been doing for years) for RtoP to find life through a regular, formal General Assembly process that allows states to (as noted by Panama) engage a wider range of stakeholders, but also to examine the political and capacity gaps that impede effective implementation. We also need (as noted by the Netherlands on behalf of the “Group of Friends”) more regular briefings to the Security Council by USG Dieng and (soon) ASG Simonovic, requiring both a more active, determined secretariat and a less “tone deaf” Security Council when it comes to its response to early warnings.

DSG Eliasson confessed during this meeting that when we look around the world, it is hard not to be discouraged. We just can’t go on like this, he implored. Indeed, we cannot.  The longer the violence festers, the longer people are denied relief and justice, the longer we fail to develop (as noted by Rwanda and others) strong institutions to help us face our conflict prevention and protection responsibilities, the longer we attempt to mask the truth about protection promises unkept, the deeper discouragement is likely to become.

Such deep and painful emotions were also the backdrop of a special event sponsored by Palau (with Canada, Belgium and UNDESA) on “Mental Health and Wellbeing at the Heart of the Sustainable Development Goals (SDGs).”  Palau’s Ambassador Otto, a trained physician himself, has taken a special interest in SDG 3 which links “mental health and wellbeing” to what some might consider as the “self-inflicted wounds” associated with non-communicable diseases, including narcotics and alcohol addictions.

Amidst the “earth balloons” and children chanting “happy people, happy planet,” there were sober matters to consider. ASG Daniella Bas underscored the particular mental health concerns of disabled persons.  Canada addressed the social isolation characteristic of so much mental illness, but also called attention to the pervasive mental health challenges affecting migrants and refugees.  Micronesia’s newly-installed, Ambassador Chigiyal, called attention to the stigmas that impact care for the mentally ill, citing examples from her own “family focused” country. And many diplomats and practitioners raised the specter of the trauma, including from indiscriminate use of weapons, that we should do more to prevent and for which our capacities for remediation and restoration are still largely deficient.

But more than this, we should think harder about what is needed at the level of policy to help stave off the effects of trauma and related illness that impede human and community development.  Beyond addiction, we are moving towards full recognition of mental health impacts from being unable to protect our children from harm or abuse, from having our livelihood disappear, from being betrayed by people in our “inner circle,” from being unable to stop violence that threatens everything in our community of concern. These and other examples point towards two features of a mentally healthful life – trustworthy human connections and the ability to impact events in the world, large and small.  Without meaningful connection and viable agency, life is simply too isolated and unpredictable to sustain mental health.  Too many of us in this world struggle mightily to find protection from harsh winds that we simply cannot control, and too often we struggle alone.

Ambassador Otto’s introductory remarks summed up perhaps the most important insight from this event, reminding us that “the heart is a great enabler.” Indeeed, implementation of all our development commitments and all our preventive and protective responsibilities must be animated by something deeper than the need for clever and well-crafted policy.  We must learn to empathize more actively with lives incapacitated by armed violence; we must do better at preventing and protecting against its devastations.  While doing this, we would do well to place greater emphasis on encouraging more personal connection and social participation as antidotes to the isolation and impotence from which so much discouragement in this world currently proceeds.

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