Duty to Warn: Ethics and Social Consequence

The past two years have been filled with anger, conflict, and stark political splits in the Culture. That these trickle down into the consultation room is doubtless.

You are invited to a series of panels and discussions on the challenging roles and responsibilities of mental health professionals in the current political climate. Panels will look at the potential dilemma between a clinician’s Duty to Warn (As mandated by the Tarasoff ruling) and the Goldwater Rule which limits clinical discussion of public figures.

What this is not. This meeting is not a partisan rally and moderators will be charged to maintain a collegial atmosphere of sharing and mutual exploration.

Book Chat: The Secrets of Happy Families

— by Hannah Lee

Who doesn’t seek family harmony? What I found compelling about Bruce Feiler’s The Secrets of Happy Families was that the author did not seek out therapists, happiness researchers, or self-help gurus. Instead, he explored different disciplines, learning how to successfully apply their results to family management. I appreciate the affirmation from outside the social sciences.

The first chapter dealt with how to deal with stress points. Two of the techniques discussed were the use of a family flowchart/checklist (children love making checkmarks) and a weekly family meeting to discuss problems. These strategies were developed in the software industry and are now used in practically all forms of product development. Two startling strategies suggest involving the children, both in devising rewards and in assigning punishment, because they then become invested in the follow-through. The author wrote about the marvelous results that led to his sharing in his children’s emotional inner life, as our children often do not open up to us in this way.

More after the jump.
Another chapter discussed how to fight smart. Feiler writes that we spend about half our days negotiating — with our spouse, our boss, our clients — but most people do not understand its nature. Managing disagreements hinge on:

  • timing (6-8pm is usually the most stressful time);
  • language (“I” and “we” are signs of a healthier relationship than “you”);
  • length (the most important points are made in the opening three minutes); and
  • body language (eye-rolling, sighing, and shifting in the seat are signs of disrespect).

For this technique, Feiler went to the experts in negotiations: Bill Ury (co-author of Getting to Yes) and the Harvard Negotiation Project, which teaches people involved in the most difficult global issues of the day. Ury’s teachings involve a five-step process:

  1. isolate your emotions;
  2. go to the balcony (to see the big picture);
  3. step to their side (to understand their reasoning);
  4. don’t reject, re-frame; and
  5. build them a golden bridge.

This last point is especially important for families, as we live with our negotiating partners and we cannot leave anyone embittered.

When Feiler visited Joshua Weiss, cofounder of Harvard’s Global Negotiation Initiative and Ury’s business partner, he witnessed one family fight amongst the Weiss daughters (aged eleven, nine, and five). It was remarkable that the five-year-old was the one who stepped in as peace negotiator, asking each sister to state her case, without interruption. The middle sister had learned other techniques, such as “Stop, Think, Control” (a child’s equivalent of going to the balcony) and to consider the other person’s feelings. The eldest girl had already mastered some adult problem-solving strategies, demonstrated in separate incidents, for going to the balcony and trying to understand the other side.

Additional chapters in the book dealt with having difficult conversations with our families, improving marital relationships, and even how smart families share space. The final part of the book covers the fun-but-trying times of family vacations, sporting events, and reunions. You might not be ready to adopt all of the insights described, but it’s certainly eye-opening to learn about them.

Feiler had already published ten globetrotting books by the age of 43 when he was diagnosed with bone sarcoma. His twin daughters were only three, so he pondered how to maintain his connection with them in the event of his death. His novel solution was to create a Council of Dads, male friends from six different periods in his life who could serve to convey his values and perspectives to his daughters when they face milestones or difficult decisions. The resultant memoir of the same name is a lively account of how these men became important people in their lives, as their friends, not just friends of their father.
 
With the book The Council of Dads and now The Secrets of Happy Families (begun after his cure), Feiler is forging a new direction, one about relationships. I cautiously predict that his new career may reach even more readers than did his first bestseller, Walking the Bible, which inspired a television series. (Readers of The Council of Dads have created their own councils to deal with the pressures of different parenting situations.) The Bible is the greatest story ever told, but Feiler’s recent two books are his own stories and they shed a different light on our world.  

Social Consequences of Food Allergy

— by Catharine Alvarez

A recent study published in Pediatrics reported that over 30% of children with food allergies say they have been bullied about their allergies. Previous studies have also found that having a food allergy puts a child at risk for bullying. I’d like to share my experience with raising two children with food allergies and examine why bullying is such a problem for this group.

Les Misérables food allergy parody “One Grain More” the story of a “Food Allergy Party” by Michael Bihovsky with Dena Blumenthal, Megan Ermilio, Lily Bayrock, Michael DeFlorio, Bernie Langer, Matthew Dorsch and Liz Sanders.

More after the jump.
Food sharing is one of the most basic social constants in human culture.  We use food as our social glue. When a group shares food, we are saying we are a family, a team, a tribe. Many cultural traditions and religious rituals involve the sharing of food. We use it both as an offering and as a way of increasing our status within the group. We use it as a way of connecting with one another. So what are the consequences when an individual cannot participate in these most basic of social interactions? Asking this question can help us understand the social stigma of food allergies.

I have two children with anaphylactic food allergies who experienced this stigma during the time they were in public school. When I was new to the world of food allergies, I didn’t understand why many people seemed so resistant to accommodating the needs of my children. Why did they feel so angry about restrictions placed on bringing treats to class for holidays and birthdays? To me, it seemed obvious that a child’s safety should be placed above custom, and yet there were a few parents and teachers who intentionally circumvented the rules, and others who obeyed, but grudgingly. I learned that they viewed the safety rules as arbitrary barriers preventing them and their children from participating in the food sharing traditions they felt were vital for their own and their children’s social connections and standing.

Now let’s look at the same situation from the perspective of a child with food allergies. Whenever cupcakes were brought to class, my son was not able to eat one. Yes, we did provide him with some other treat, but the deeper message was that he could not share what the others were eating, and was not part of the group. Every event based on food sharing was a reminder of his separateness. It was also a reminder that the adults in charge did not think he was important enough to be included.

An example of the kind of food sharing interaction we all take for granted:
A parent comes to the class bringing cupcakes. Each student is offered a cupcake and enjoys the sweet treat. The students’ trust and liking for this parent is increased. The birthday student is a celebrity for a day, and when the other kids have their birthdays, they ask their parents to bring cupcakes.

What happens when there is a student with a food allergy in the class:
A parent brings cupcakes to class. My son is offered a cupcake, but he must say, “No thank you, I have food allergies.” He is allergic to egg, and these cupcakes almost certainly contain egg. This is the first moment where the food sharing ritual breaks down. The food allergic person is forced to refuse the offer of food. In many cultures, refusing an offer of food is considered rude. Even though he gives the reason (food allergies) this is often not accepted. People become defensive, and don’t believe that the allergy is real or serious. They offer objections: Their friend’s child is allergic to egg but can tolerate baked goods, so this cupcake is okay. A little bit won’t hurt. They are pretty sure the item doesn’t contain eggs, and so on. To them, his rejection of the food feels like a rejection of the person offering it.

Children with food allergies are put in the difficult social position of having to stand up to adults who are determined to give them unsafe food. My son tries to mollify them by saying, “It’s okay, I have my own treat.” Or he will take it and “save it for later,” but trying to avoid the stigma of the food allergy by saying that he is not hungry is not very effective because this is also seen as a rejection of the person offering the food. Eating his own treat does not serve the same symbolic social function as sharing what everyone else is eating. In fact, it carries the opposite meaning: he is separate, and not part of the group. Having to refuse the offered food sends the message, “I don’t trust you, and I don’t want to be part of your group.”

Even if the food allergic student’s parents try to compensate by bringing safe food to share with the whole group, the inability to reciprocate by accepting food from others creates stigma. When the parent of a food allergic child overcompensates by bringing multiple offers of food to the group, that is often met with resentment from the other parents who feel they are not given equal opportunities to share. This is a no-win situation, and the resentment of the group is expressed as ostracism of the allergic child and his family.

Many times, excluding the allergic child is rationalized:

  • He needs to get used to being left out because food allergies are a fact of his life.
  • Kids shouldn’t feel entitled to special treatment; the world isn’t going to change for them.
  • She’s used to being left out; it doesn’t bother her.
  • This child’s parents are overprotective; this level of caution is unnecessary.
  • Other people with food allergies can eat this, so this should be good enough for her, too.

The reality is that kids with food allergies get plenty of practice at being excluded. Far from feeling entitled to special treatment, they internalize the message that their food allergies are a burden to others. Children with food allergies do not take inclusion for granted. This is especially true for children with multiple food allergies, or who are highly sensitive to the allergens. They are at the greatest risk for stigmatization because the necessary precautions seem unusual to people. In addition, there are many people with food allergies who are not aware of best practices for food allergy management, and their casual approach to the risks involved is seen as more socially acceptable.

Modeling exclusion

My daughter’s teacher once decided to bring candy to the class for Easter. Since it was a last minute decision, the teacher didn’t take the time to ask me which candy was safe for my daughter who is allergic to peanuts. She gave the candy to all the children, including my daughter who tried to refuse it. When my daughter wouldn’t eat the candy, she was told she could eat a leftover part of her sandwich from her lunchbox while her classmates enjoyed the candy. My daughter was six years old.

When adults exclude the child with food allergies, they are modeling exclusion for everyone. They are sending a message to all the kids that it is okay to exclude the allergic child, and a message to the allergic child that they are not worth including. Many kids with food allergies are bullied at school because of this social stigma. Allergic children deserve to feel safe and that their well-being is important to the adults in charge. They deserve to have their basic needs for safety and inclusion met.

Take a moment to look at this diagram. If it looks familiar, that is probably because it is based on Abraham Maslow’s Hierarchy of Needs. Notice that the need to belong is part of the base of the pyramid. We are all social beings, and belonging is a basic, human need. The power of that need is probably greatest in adolescence, and that is reflected in the fact that teens are at a greater risk of dying from their food allergies than younger children. Years of social stigma take their toll, and teens may place a higher priority on inclusion than safety. And in the school context, when kids’ basic needs are not being met, their ability to learn is compromised.

If we can bring awareness to these very human reactions, we can choose to respond differently. We can choose to include kids with food allergies. This is going to require effort because accommodating food allergies means conscientiously checking ingredient labels and carefully cleaning cooking utensils and surfaces. It means talking to the child’s parents to find out what is safe. It means accepting that those parents may not feel comfortable trusting their child’s life to home baked cupcakes, and choosing to center a party around non-food activities instead. It means remembering that families with food allergies live with those inconveniences every day. Most kids take being included for granted. Imagine what it means to a child with food allergies.

What can you do?

As a parent of a child with food allergies you can:

  • Advocate for inclusion at school, and help raise awareness
  • Mitigate some of the exclusion by volunteering to share safe food
  • Support your child’s self-advocacy efforts

As a teacher you can:

  • Choose to use non-food items for class projects, manipulatives, and incentives
  • Promote celebrations that focus on activities rather than food
  • Support the self-advocacy of children with food allergies

As a parent of a child without food allergies you can:
Choose to send non-food treats for holidays and birthdays
Make an effort to include the allergic child in social events outside of school
Model compassion for kids with food allergies to your own children

Catharine Alvarez, PhD studied applied mathematics at the University of California, Berkeley. She is currently home schooling her two children while independently studying psychology and game theory.

She writes about education, food allergies, advocacy, and mathematics, and moderates online interest groups for food allergies and math education.