Discrimination against adoptees rooted in fears of illegitimacy

(Note: To learn more about my forthcoming memoir and study of adoption in the United states, visit the You Don’t Know How Lucky You Are website. © 2017, Rudy Owens. All rights reserved. )

Rudy Owens, as a young child, and later someone denied equal treatment under the law because of my status as both an adoptee and someone born
Rudy Owens (the author), as a young child, and later someone denied equal treatment under the law because of his status as both an adoptee and someone born “illegitimately.”

One of the issues seldom if never discussed in the long-simmering debate over adoptees’ legal right to their original birth records is how deeply prejudice harms millions of adopted persons.

Discrimination can be seen in how adoptees seeking their birthright to know themselves and obtain copies of their original birth records are treated. By law, they are not considered equal to others in the majority of U.S. states. Many who enforce outdated state laws treat adoptees dismissively—even as threats. (See copies of emails written by senior Michigan public health officials how they responded fearfully to my request for my original birth certificate, as just one example.)

This prejudice is older yet also connected to the historic stereotyping of them by mental health professionals, who for decades described adoptees searching for records as mentally ill and classified this in their handbook on psychiatric disorders. Through the 1980s, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders identified the problem it labeled “identity disorder,” which consisted of “severe subjective distress regarding inability to integrate aspects of the self into a relatively coherent and acceptable sense of self.”

As adoption historian E. Wayne Carp writes, “No adopted person in the 1970s had imagined that asking the question ‘Who am I?’ would end up classified as an official psychiatric disorder.”[1]

This should not be a surprise, given how illegitimately born people have been treated, globally and throughout history. Denying this history in the larger policy discussion of discrimination of adoptees is to deny the role that bias and stereotypes play in our thinking and deeds. We know bias can be found in countless behaviors: those done personally and those made professionally.

There is no reason to think one of the greatest and most universal forms of stigmatization, against so-called “illegitimately” born people, who include most U.S. adoptees, would not persist and be masked and even not noticed by those who discriminate. This includes the actions of lawmakers who passed laws for decades discriminating against adoptees, of the media who stereotype adoptees, and of those who interpret and enforce these Jim Crow-style laws that treat adoptees as persons with lesser rights.

How Stereotyping Works Against Adoptees

Researchers in many fields—law, criminal justice, history, neuroscience, psychology, sociology, anthropology—have long investigated prejudice and how humans practice it. Researchers have even begun looking how prejudice works at the neurological level. Researcher David Amodio notes, “Although they are distinguishable by content and process, prejudices and stereotypes often operate in combination to influence social behaviour [sic]. Moreover, both forms of bias can operate implicitly, such that they may be activated and influence judgements [sic] and behaviours [sic] without conscious awareness.”[2]

Today, adoptees remain victims of systemic legal discrimination in seeking equal treatment under the law by requesting their original birth records. There is no credible evidence anywhere that the overwhelming majority of adoptees seek anything more than to be reunited with their kin in seeking their original records.[3]

However, defenders of closed records have made repeated and unsubstantiated claims from the 1940s onward that adoptees or birth mothers might wish to exact revenge or extortion. Adult adoptees seeking their records have been denounced by opposing attorneys and adoptive parents, who claimed the information could be used by the adoptee to “find and murder” biological parents or that granting a records request was the equivalent of giving away a “hunting license.”[4]

David Kirschner's imaginary diagnosis that stigmatized adoptees can still be found in publications, despite being discredted as a fabrication nearly three decades earlier.
David Kirschner’s imaginary diagnosis that stigmatized adoptees can still be found in publications, despite being discredited as a fabrication nearly three decades earlier.

The lingering urban legend that may have influenced lawmakers and those charged with managing adoption records from the 1980s onward was the so-called “Adopted Child Syndrome.” Some unethical lawyers used this controversial defense in several murder trials in the 1980s. These lawyers tried to show that adoptees accused of killing their parents suffered from a mental health issue called Multiple Personality Disorder. According to the argument fabricated by psychologist David Kirschner, the Adopted Child Syndrome could prove adoptees encounter more psychological problems in their childhood and adolescence unique to being adopted. The manifestations were promiscuity, lying, stealing, substance abuse, and more, all showing a “toxic potential of adoption.”[5]

The theory argues adoptees acted out of “extreme disassociation.” Though this entirely fictional and discredited theory attracted national attention from the tabloids, he later revealed he prepared the concept for a trial at which he testified in 1986. He admitted he had not done proper research and the sensational theory was in fact a product of his imagination.[6] Yet, the damage had been done and fed the old stereotypes many clung to.

Adoptees and Bastards Are the Victims, not Perpetrators, of Harm

This stereotype is one I personally encountered when I tried to access my records and later interviewed one of the managers whose office managed those records for the Wayne County Probate Court. In reality, it was illegitimate children and their mothers who were the victims, not perpetrators, of crimes and the ones who paid the price for societal attitudes, including with their lives. This is substantiated solidly in population health records, which provide actual data on health and mortality outcomes.

As a modern social institution, adoption laws only date to the 19th century in the United States. Labeling illegitimate children as society threats and bogeymen, however, far precedes the U.S. adoption system and the laws that govern it. Societies over time have addressed these fears, often brutally and lethally for the unlucky illegitimate. Normally, the “bastards” have been ostracized, but also outright killed not very long ago.

The United States inherited European and English legal traditions, which prescribed clear rules how infants would be classified as legitimate in the eyes of society and illegitimate. Roman law, canon law of the Catholic Church, and English law all adhered to the rule that only children born legitimately inside of approved marriages were deemed legitimate. Those who were conceived outside of wedlock were not. While there have been changes to parts of family law that cover how children are legitimized, the basic principle behind legitimation is still mostly unchanged.[7]

the-outcast-painting-in-royal-academy-of-arts-london-1851
The Outcast, by Richard Redgrave, 1851, Royal Academy of the Arts, London, documents the treatment of bastardy and birth mothers in England in the 1800s.

From a purely sociological perspective in human societies, the appearance of children has to be prevented for whom no adult male, permanently allied to the mother, can be held responsible as the father. This is required in order to safeguard the future of any given society.[8] This societal need is both ubiquitous and historic. This idea is at the heart of anthropologist Bronislaw Malinowski’s Principal of Legitimacy, which proposes “no child can be brought into the world without a man, and one man assuming the role of sociological father.” That man serving that role does not necessarily have to be biological, but must provide a link between the child and the community.[9]

Malinowski first published this idea in 1930. Others who have studied the issue since note that illegitimacy is a category that will be found at every point in the past of every society, as well as in all present societies. Many have since challenged this idea, pointing to high levels of out-of-marriage births in parts of the Caribbean and, since the late 1970s, the United States. That said, the idea of legitimacy prevails, even though it is not adopted in practice.[10] Overall, illegitimacy is and always has been regarded as a negative—the breach of an established rule, never considered an outcome of an approved sexual or child and reproductive behavior.[11]

Bastards and illegitimate children have always faced societal scorn, and they paid severe and deadly consequences for it. Today, a likely contributing factor to poor health outcomes for adoptees is societal stigma, and its multivariate impacts on unmarried mothers and their illegitimate kids. Despite the political correctness of the term adoptee, the underlying truth known to everyone, from the adoptive parents to the adopted children to society at large, is that adoptees are bastards. Adoptees more than any other person alive today know this fact. It is a fact I always knew, and so did nearly everyone around me, including peers my age. Today, such children still bear the stigma as being born illegitimately, despite the high prevalence of children born outside of marriage that has made their status ubiquitous.

Population Records Show High Mortality and Poor Health for Bastards and Illegitimate Children

bastard-examination1
William Hogarth depicts bastardy examinations (1729), in which justices enquired how a woman about to give birth to a bastard child had fallen pregnant. Legally a woman who knew herself to be likely to bear a bastard child had to present herself for examination, but in practice this only occasionally happened, and many examinations occurred after the birth. Bastardy examinations tried to discover the identity of the father, in order to force him to provide a bond to defray the parish against the costs of maintaining the child, many who were cared for in workhouses depicted in brutal form by Charles Dickens in Oliver twist. Courtesy of London lives, found at: https://www.londonlives.org/static/EP.jsp.

Historically, illegitimate infants in recent history have been among most vulnerable population groups, documented in birth and mortality records. In fact, the historical study of illegitimacy, or bastardy as many demographic historians call it, is among the best documented of any topics in history because the research has relied on mostly reliable demographic data, such as baptism and death records, in Europe from the 1500s on, as well as in pre-20th century America.

Cambridge historian Peter Laslett, who contributed to an exhaustive study of the topic in 1980, notes that illegitimacy has been viewed in many cultures for centuries as “pathological.” The mothers who gave birth to bastards were perceived as “victimized, disordered, even mentally abnormal.”[12] The numbers from these old data sets from across Europe and early America from the 1500 on paint often horrific outcomes for birth mothers. Outcomes could be worse for the infants who died at rates that suggest infanticide in many instances.

oliver-twist-cover
Charles Dickens’ Oliver Twist portrayed the harsh lives of “foundlings” (abandoned bastard infants), left to cruel fates in England’s workhouses.

In the 18th and 19th centuries in the United Kingdom, infants who were born out-of-wedlock were about twice as likely to have died before reaching their first year of life compared to their peers born in sanctioned marriage. Poor and unmarried pregnant women frequently took refuge in the country’s notorious workhouse, which housed and fed the poor and forced them to do often-brutal labor, captured in the writings of Charles Dickens’ Oliver Twist. Many of the children confined to them faced early deaths. In 1760, four in five infants born in workhouses or left there by their birth mothers died before reaching their first birthday.

A picture for the sheer lethality of being born as a bastard emerges from the records collected in the middle England market city of Branbury, between 1561 and 1838. The number of bastard children with baptism and burial records made up 18 percent of all recorded persons—a high number. However, the rates of infant deaths were at best catastrophic for those unlucky to being born a bastard. Records show that 70 percent of all of these bastards born during these 277 years died before reaching the age of 1. Only 21 percent lived to the age of 1, and just 5 percent reached the age of 5. A mere 1 percent of bastards made it to the age of 30.[13]

Other findings of higher infant mortality can be traced in the records of births and deaths of infants over the last 100 and more years in Europe. Jenny Teichman, author of Illegitimacy: An Examination of Bastardy, reports “there is a persistent and significant difference between infant mortality rates of legitimate and illegitimate children.” Her study found that mortality ranges for the two groups ranged from 50 to 150 percent higher for both English and Norwegian illegitimate infants, looking at national records between 1914 and 1973 at four different points in time. Teichman notes even at English public hospitals through the 1960s, doctors and nursing staff “refused anesthetics to unmarried women in childbirth ‘to them a lesson.’”[14]

A bastard’s prospects in the English colonies in North America were not much greater than those born in Europe. Infanticide likely became a common practice in the United States in the 1700s. Virtually every colony in North America passed legislation that declared, unless witnesses would swear to seeing a childbirth, the mother of a dead infant would be presumed guilty of murder.[15] Things did not improve, even through the end of the 1800s. Nearly a century later in the early 1970s, infant mortality in the United States was 73 percent higher for children of unmarried mothers then their peers from families with married parents.[16]

The findings also are not unique to the Western world. One seminal study on the sociology of illegitimacy published in 1975 found that as of the mid-1960s, in every nation globally that tracked child health data, fetal and infant mortality were higher for illegitimate than legitimate children.[17]

While the penalty for illegitimacy as measured in infant mortality rates did fall in the last century, data from the first years of the 21st century shows illegitimate infants in England and Wales are still 30 percent more likely to die before their first birthday than legitimate infants.[18] Remarkably, evidence shows children reported as illegitimate but registered to both parents living at the same address are still 17 percent more likely to die in infancy.[19]

Today excess infant mortality tied to illegitimacy remains a legitimate health concern. Multiple risk factors contribute to the outcome. Single parents have less disposable income. They likely have worse housing. A single parent likely works full-time. Children likely are weaned off health breast milk earlier. The stigma of illegitimacy and societal scorn directed unfairly to unmarried mothers might reduce their ability to keep their children healthy. Unmarried women may also have come poor social positions, and thus be more vulnerable to having a child out-of-wedlock.

The Murder of Relinquished Infants in the United States, A Little-Known Crime

The New York Times covered the findings of the investigation of the horrific conditions that killed nearly four in five relinquished infants in Baltimore, in 1914.
The New York Times covered the findings of the investigation of the horrific conditions that killed nearly four in five relinquished infants in Baltimore, in 1914.

In the early 1900s, before reformers from groups like the Child Welfare League of America and other benevolent groups intervened, illegitimate babies were boarded and trafficked at so-called baby farms in the United States. One highly publicized 1914 report called the Traffic in Babies, by Dr. George Walker, reported on virtual charnel houses for unwanted, abandoned, and illegitimate children. These reportedly operated to “save” the single women from the disgrace of being unmarried mothers. The description by Walker is noteworthy because of his focus on maternal and child health practices that are unquestioned today. He also described how poor public health practices for abandoned babies served as the functional equivalent of homicide.

“Day after day, month after month, they received healthy, plump infants into their wards and watch them hour after hour go down to death,” wrote Walker. “They know that practically all of those that immediately after birth are separated from their mothers will die; yet year after year they keep up their nefarious, murderous traffic. We do not attempt in this study to settle the many complex problems relating to the illegitimate; but we believe that the facts show that society’s method in many instances is one of repression and virtual murder. This is a hard word, we grant, and we would fain substitute a gentler term; but, after all is said and done, that which we have recorded is virtual murder, and slow and cowardly murder at that. It would be bar more humane to kill these babies by striking them on the head with a hammer than to place them in institutions where four-fifths of them succumb within a few weeks to the effects of malnutrition or infectious diseases.”[20]

Even with the mortality rate of relinquished, out-of-wedlock children as high as 80 percent, this fact did not curb the practice of punishing the children born out-of-wedlock by professionals and religious leaders. Some doctors, nurses, midwives, clergymen, and hospital administrators actively referred the disgraced mothers who had sex out of marriage and became pregnant to these lethal, for-profit baby shops.[21] Some hospitals even took a cut from the baby trade that ferried bastard babies to their likely deaths. Walker’s summary notes hospitals had different methods of disposing of unwanted babies permanently: “There is an old woman, called ‘Mother—’, who carries the babies from the hospital to this institution; she gets $5 for this service. At another hospital, the nurses have charge of separating the infant from its mother; they make all the business arrangements; receive the money, and send the baby to Institution No. 1 by an old black woman, who carries it in a basket.”[22]

History of Bias Against Adoptees Not Acknowledged by Adoption System

These acts all occurred a mere five decades before my birth, as someone born illegitimately and as a bastard. They demonstrate how powerful stigmas against bastard-born children were in recent memory—strong enough to create a system that ensured bastard infants’ likely death in institutional care. Adoption, as a cause championed by Progressive reformers from 1910 through 1930 was a solution that offered a way to eliminate the stigma, mortality risks, and lifelong barriers posed by illegitimacy.

Today, most states still deny adoptees full equal rights and partially and outright restrict them from knowing their past by denying them their original birth records. If one polled any state public health office where these discriminatory laws are practiced on a daily basis, I would wager the staff would never admit their behavior and treatment of adoptees seeking those records is connected to these deeper underlying fears and biases.

My decades of experience and the dark but carefully documented record of human behavior to everyone who is not “legitimate” show me that I must accept that prejudice is still hardwired into how adoptees are treated and will be treated into the future. Like it or not, adoptees will forever be bastards and illegitimate children. Everyone knows that when someone says they are adopted.

An adoptee’s taboo status helps to reinforce biases they face and will continue to face from the record keepers. Those so-called public health professionals and adoption bureaucrats will fall back on these old tropes, frequently unknowingly, and fail to serve adoptees’ interests in states that discriminate against those seeking their birth records. The best remedy remains strong laws that ultimately open all birth records to adult adoptees, similar to national laws in many countries, including England.

Other suggested readings on bastardy in an English historical context:

  • Black, John. “Who Were the Putative Fathers of Illegitimate Children in London, 1740-1810?.” In Levene, Alysa; Williams, Samantha; and Nutt, Thomas, eds, Illegitimacy in Britain, 1700-1920. Basingstoke, 2005.
  • Black, John. “Illegitimacy, Sexual Relations and Location in Metropolitan London, 1735-85.” In Hitchcock, Tim and Shore, Heather, eds, The Streets of London: from the Great Fire to the Great Stink. 2003.
  • Snell, Keith D. M. Parish and Belonging: Community, Identity, and Welfare in England and Wales, 1700-1950. Cambridge, 2006.

Footnotes:

[1] E. Wayne Carp, Jean Paton and the Struggle to Reform American Adoption (Ann Arbor: University of Michigan Press. February 2014), 290.

[2] David M. Amodio, “The Neuroscience of Prejudice and Stereotyping,” Nature Reviews Neuroscience, 15(10) (2011), 670.

[3] Elizabeth J. Samuels, “The Idea of Adoption: An Inquiry into the History of Adult Adoptee Access to Birth Records,” Rutgers Law Review 53 (2001), 367.

[4] Samuels, 411.

[5] Ellen Herman, Kinship by Design: A History of Adoption in the Modern United States (Chicago: Chicago University Press, 2008), 282.

[6] E. Wayne Carp, Family Matters: Secrecy and Disclosure in the History of Adoption (Cambridge, MA and London: Harvard University Press, 1998), 188.

[7] Jenny Teichman, Illegitimacy: An Examination of Bastardy (Ithaca: Cornell University Press, 1982), 28.

[8] Peter Laslett, “Introduction: Comparing Illegitimacy Over Time and Between Cultures,” in Bastardy and Its Comparative History, ed. Peter Laslett, Karla Oosterveen, and Richard M. Smith, (Cambridge: Harvard University Press, 1980), 5.

[9] Teichman, Illegitimacy, 89.

[10] Shirley Foster Hartley, Illegitimacy (Berkeley : University of California Press, 1975), 5.

[11] Laslett, Bastardy, 5.

[12] Laslett, Bastardy, 2.

[13] Susan Stewart, “Bastardy and the Family Reconstitution Studies of Banbury and Hartland,” in Bastardy and Its Comparative History, ed. Peter Laslett, Karla Oosterveen, and Richard M. Smith (Cambridge: Harvard University Press, 1980), 127.

[14] Teichman, Illegitimacy, 105.

[15] Robert V. Wells, “Illegitimacy and Bridal Pregnancy in Colonial America,” in Bastardy and Its Comparative History, ed. Peter Laslett, Karla Oosterveen, and Richard M. Smith (Cambridge: Harvard University Press, 1980), 360.

[16] Hartley, Illegitimacy, 8.

[17] Hartley, Illegitimacy, 8.

[18] Reid Alice, Davies Ros, Garrett Eilidh, Blaikie Andrew, “Vulnerability Among Illegitimate Children in Nineteenth Century Scotland,” Annales de démographie historique 1, no. 111 (2006), 89.

[19]  Alice, Ros, Eilidh, Andrew, “Vulnerability Among Illegitimate Children in Nineteenth Century Scotland,” 90.

[20] George Walker, The Traffic In Babies: an Analysis of the Conditions Discovered During an Investigation Conducted In the Year 1914 (Baltimore: The Norman, Remington Co., 1918), 3.

[21] Barbara Melosh, Strangers and Kin: The American Way of Adoption (Cambridge, MA and London: Harvard University Press, 2002), 19.

[22] Walker, The Traffic In Babies, 16.

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One of the best little health books ever published

Few books stay with me for long. I read them and give them away. One has stayed on my bookshelf, now for 26 years. That book is Dr. Stephen Bezruchka’s The Pocket Doctor. First published in 1982 by the Mountaineers, this pocket-size reference, now being published at a bit more than 100 pages, is exactly what its title implies. It is a guide to help a traveler cope with illnesses many people in the developing world face daily. You can buy it online from many vendors, like Powell’s Books.

The Pocket Doctor Cover
Cover of the second edition, 1988 version of Dr. Stephen Bezruchka’s The Pocket Doctor (personal copy).

I credit this book for saving my bacon and mental health on several best-forgotten nights. It helped me cope with medical problems that are normal for hundreds of millions of residents globally, and for me something I did not experience back in the comfort of the United States. But I am not the only writer and traveler who praises Bezruchka and his book.

Why many trust Bezruchka’s work

Bezruchka is a Canadian-born former emergency-room doctor trained at some of the nation’s best universities (Standford, Harvard, Johns Hopkins). He has both an MD and MPH. He has worked with medical specialists in the developing world, notably Nepal for 10 years. He also has written a great guide called Trekking in Nepal, which I used back in 1989. Today he is a lecturer on global health at the University of Washington School of Public Health (UW SPH) and a nationally recognized advocate for health care reform to improve public health outcomes and to eliminate health and income inequality.

I have taken this book with me now to three continents: Asia, Africa, and South America. I just cannot say goodbye to it, even when my developing-nation jaunts seem fewer and fewer.

The advice it provides has helped me to self-diagnose all manners of common gastrointestinal disturbances, such as food poisoning (nasty and scary in a crappy place), dysentery, and common diarrhea. I also used it to help me obtain the necessary medicine for what I still believe was malaria, which I had in Kigali, Rwanda in 1997.

With this book in my hand, I felt I could handle the predicaments that afflict visitors from developed countries to less-developed areas. In my 1988 published version, 13 pages are devoted to common drugs and medicines that address typical maladies, such as the  antibiotic ciprofloxacin, to tackle infections, with information laid out in a table on a drug’s use, likely place of need (city, remote, “third world”), form, and dosage.

Basic health care advice can be fun with good writing

Bezruchka’s writing is straightforward and direct. In his chapter on drugs, he begins his recommendation with a simple message: “Remember that drugs, though valuable, are not a cure all.” He provides advice on assembling a medical kit, working with doctors at home and abroad, and dealing with major sources of health problems—namely, food and water.

Bezruchka also highlights a major global health issue that is more severe than microbial agents, trauma from vehicle accidents. “Trauma, especially that caused by motor vehicle accidents results in the majority of disability acquired in developed countries,” writes Bezruchka. “This is even more true in third world countries. Trauma causes more disabilities to travelers in foreign countries than all the exotic diseases put together.” That observation remains true to this day, as shown in global health data.

Photo courtesy of the University of Washingston School of Public Health faculty photo.
Faculty photo of Dr. Stephen Bezruchka, courtesy of the University of Washingston School of Public Health web site.

But there is much more. Rabies? Check. Animal attacks? Covered. Ticks and leeches, fever, rashes? All addressed. The two-page section, in my old and battered version, on dealing with stress in less-developed nations is a classic summary of what many first-world travellers experience.

“If the culture shock of a third-world setting with its attendant poverty and hopelessness have you in despair, take steps to improve your psyche,” writes Bezruchka. “Seek out help, another traveler, or a religious organization or individuals.”

Bezruchka even has sections on death and how to cope with returning from travels with an illness. I definitely experienced lingering issues when I came back and took this advice to heart.

Meeting Bezruchka later in life

When I first met Bezruchka in person during my studies at the UW SPH, I mentioned how much I enjoyed his book and used it frequently in Nepal. I even mentioned how enterprising Nepalis had published black-market copies of his book they were peddling on the streets in Kathmandu. As I recall, he considered that a compliment to the value of his work.

Sometimes small and perfectly executed creations are ones that have the most impact. In Bezruchka’s case, there is far too much to choose from to say what is best—from published papers to advocacy to mentorship of future health leaders. I will submit this still fine tome as work that stands the test of time and proves that small is often better.

Viktor Frankl and the simple secrets to living a meaningful life

Viktor Frankl Photo
This photo of Viktor Frankl was taken shortly after his liberation from the Nazis in 1945.

Renowned psychiatrist, philosopher, and writer Viktor Frankl stands as a giant among 20th century thinkers. The Austrian-born Frankl (b. 1905, d. 1997) was a psychiatrist whose life was transformed by his experiences as a Jewish prisoner who survived the Holocaust and internment at the Auschwitz death camp and three other German concentration camps.

With the exception of a sister, all of his immediate and extended family and his beloved wife were murdered by the Nazis. From the aftermath of this horrific experience, he embarked on a life’s work that provided deceptively simple but remarkably clear ideas that literally provide a framework on how all people can live meaningful lives.

Frankl survived his brutal internment, which should have killed him, by seeing a purpose in his ugly reality and by taking control of his responses to that experience with positive actions and a mental attitude that ensured his survival and also his outlook on life and his fellow man and woman. His simple ideas offer no shortcuts, and they uncomfortably place each person in control of how they choose to respond to life’s challenges, even ones as unforgiving as genocide and mass murder.

Frankl proposes all of us are motivated to seek a higher purpose, even when our circumstances are as cruel as a death camp surrounded by barbed wire and vicious men armed with machine guns. Frankl writes: “Man’s search for meaning is the primary motivation in his life not a ‘secondary rationalization’ of instinctual drives. This meaning is unique and specific in that it must and can be fulfilled by him alone… .” More than pleasure, more than material things, meaning motivates us all. It is our purpose for being.

Man’s Search for Meaning, a book that changed modern thinking

Cover Man's Search for Meaning
Viktor Frank’s seminal 1946 Holocaust memoir, Man’s Search for Meaning, has been translated into more than 20 languages, has sold more than 10 million copies, and is considered one of the most influential books among American book readers.

Frankl published those principles in his highly acclaimed and influential 1946 memoir, Man’s Search from Meaning, which today has been translated in more than 20 languages and has sold more than 10 million copies. It is considered among the most influential books in the United States, according to a Library of Congress survey.

He originally developed the framework for his sparse set of powerful ideas when he was practicing psychiatry in Vienna before the Nazi occupation and saw how he could help patients overcome their suffering by making them aware of their life’s calling. His treatise, stashed in his coat, was literally lost when he was imprisoned.

Later in his life, when he had achieved global recognition because of the widespread popularity of his bestseller, he was asked by a university student: “…so this is your meaning in life… to help others find meaning in theirs.” His reply was as clear and direct as the theory behind his therapy, “That was it, exactly. Those are the very words I had written.”

As one writer influenced by Frankl, Genrich Krasko, points out, Frankl’s ideas are more prescient today, given millions have no meaning in their lives, particularly in affluent societies: “Viktor Frankl did not consider himself a prophet. But how else but prophetic would one call Frankl’s greatest accomplishment: over 50 years ago he identified the societal sickness that already then was haunting the world, and now has become pandemic? This ‘sickness’ is the loss of meaning in people’s lives.”

Logotherapy, Frankl’s foundational theory

Frankl called his system logotherapy, derived from the Greek word “logos,” or “meaning.” It has been called existential analysis, which may over-simplify its scope. The philosophy and medical practice boils down to providing treatment through the search for meaning in one’s life. Its utterly basic but ultimately powerful foundational ideas are easily summarized:

  • Life has meaning in all circumstances, even terrible ones.
  • Our primary motivation in living is finding our meaning in life.
  • We find our meaning in what we do, what we experience, and in our actions we choose to take when faced with a situation of unchangeable suffering.

Frankl notes, “Most important is the third avenue to meaning in life: even the helpless victim of a hopeless situation facing a fate he cannot change, may rise above himself, may grow beyond himself, and by so doing change himself. He may turn a personal tragedy into triumph.” This latter point is particularly poignant, as it calls out the role that adversity can have in shaping us and our destinies and improving our character and our life’s narrative.

In short, no matter what circumstances we find ourselves, so long as we have a purpose, we can find fulfillment. What’s more, we are fulfilled by right action and by “doing,” not through short-term pleasure or narcissistic pursuits.

Frankl argues that meaning can be found in meaningful, loving relationships, in addition to finding it through purposeful work or deeds. In fact, it was the strong love of his first wife that kept him alive amid the unspeakable horrors of Auschwitz. He felt her presence in his heart and it literally let him live when others around him perished.

Frankl’s core ideas at odds with more ‘accepted’ health and mental health paradigms

Frankl’s ideas collide with behaviorist models, which show that conditioning will determine one’s responses—the proverbial Pavlovian dog or Skinnerian lab rat. By contrast, through his own experiences and those he observed treating depressed and suicidal patients before and after the war in Vienna, Frankl claims that “everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances.”

When faced with a situation, we all chose. But our power is defined by our actions. “Between stimulus and response, there is a space,” he claims. “In that space is our power to choose our response. In our response lies our growth and our freedom.”

The concept of personal choice conflicts with extensive research that clearly documents how one’s environment, race, socioeconomic status, and more—the so-called social determinants of health (SDOHs)—shape one’s life more than one’s individualistic decisions.

A model explaining the social determinants of health.
A model explaining the social determinants of health.
Viktor Frank photo 1947
This photo of Viktor Frankl was taken two years after his liberation from the Nazis, when he returned to psychiatric practice to help people through his principles called logotherapy.

For two years, while earning my MPH at the University of Washington School of Public Health from 2010 to 2012, I found myself frequently and painfully at odds with current research and literally thousands of studies that proved to me that SDOHs will impact our lives in the most profound ways.

Yet I found the field and its most ardent practitioners lacking an explanation that showed the real power people have in controlling their personal outcomes. This is something that the public health field and my faculty sharply criticized by showing the medical model, which tells persons to control their health, has largely failed to promote wider population health metrics.

While I do embrace a “policy and systems” approach, I even more strongly believe that every person has the ability to make life-changing choices, every minute of every day—from the food they put in their mouth, to devices they watch daily, to the people they associate with, to the jobs they take or do not take (however awful often), to the way they manage their personal emotions. They have choices, and often they are cruel and brutally unfair choices, which often favor the privileged.

Frankl was famous for meeting with some patients, asking them to reflect on finding meaning in their lives over their entire life span, and providing the mental treatment they needed to take control of their lives without future interventions or drugs, which predominates the American model of mental health treatment. Some of his patients only required one session, and they could resolve to deal with life’s circumstances without any further intervention.

This is a radically and in fact dangerous model that challenges how the United States is grappling with mental illness nationally, though many practitioners use Frankl in their work. One psychiatrist I tweeted with wrote me back saying, “I’m far from the only one [using Frankl]! There’s a large humanistic community in the counselling/psychotherapy world.”

Frankl’s ideas continue to be studied, refuted, debated, and argued by learned and well-intentioned academics, which I think would amuse Frankl. He was more interested in the practical work of day-to-day living and less with becoming the subject of a cult following.

As one commentator I saw in a documentary who knew Frankl noted, Frankl was not interested in fame, otherwise he would be more famous today.

Paul Wong is one of many academics who have analyzed the ideas of logotherapy and mapped them in published work.
Paul Wong is one of many academics who have analyzed the ideas of logotherapy and mapped them in published work.

Here is just one example showing how theorists explain logotheraphy; see the table by Paul Wong on life fulfillment and having an ideal life.

Why Frankl’s thinking profoundly inspired me and thousands of others

For more than three decades, I have been wrestling with the concept of personal responsibility and the influence of our environment and systems that impact our destinies. Such factors include one’s family, country, religion, income, the ecosystem, our diet, and political and economic forces, among others.

I also have been fascinated by examples of people choosing hard paths in dire circumstances as the metaphor that defines successful individuals’ life narratives. In Frankl’s death camp reality, this ultimately boiled down to choosing to be good, and helping fellow prisoners, or choosing to partake in evil, which many prisoners did as brutal prisoner guards called kapos.

No one gets a free pass in this model, and all people in all groups can be one or the other, Frankl says. “In the concentration camps, for example, in this living laboratory and on this testing ground, we watched and witnessed some of our comrades behave like swine while others behaved like saints,” writes Frankl. “Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions.”

I had not been able to order these two lines of thinking into a coherent set of principles, as Frankl so perfectly did. When I stumbled on him quite by accident or maybe design this summer, while reading books by Robert Greene and even management guru Stephen Covey, I had that most rewarding and delicious feeling of “aha.” It was more like, “Wow, what the hell was that!”

It felt like a thunderclap. I almost reeled from the sensation. I then began to tell every single person I know about Frankl, and I learned many of my colleagues had already read him. I felt robbed not one teacher or academic, at three respected universities I attended, had covered or even mentioned Frankl, when his ideas are foundational to our understanding of the fields of psychology, public health, business, organizational behavior, religion, and the humanities in the 21st century.

Frankl deserves vastly more attention then he is given by health, mental health, and social activist thinkers. That is a shame too, because as a speaker, Frankl brimmed with enthusiasm and could convey complex ideas in the simplest ways to reach his audience. Watch his presentation at the University of Toronto–a brilliant performance.

Frankl’s ideas matter to each of us, in everyday life

Photo courtesy of PBS, showing a pensive and thoughtful Viktor Frankl (http://www.pbs.org/wgbh/questionofgod/voices/frankl.html)
Photo courtesy of PBS, showing a pensive and thoughtful Viktor Frankl. Click on the photo for a link to the web site.

One my most satisfying feelings is discovering that one’s personal life experiences and ideas on issues as big as the meaning of life also resonate profoundly with millions of others—those who have read his work. Even more gratifying is discovering that the core principles to living life amid hard choices can be grounded in principles that can help everyone, even in the most dire of personal experiences.

My own travels in the developing world stand out for me. I met countless people facing vastly more painful, difficult, challenging lives than I have faced. Yet, the wonderful people I met had nothing but smiles and treated me with genuine sincerity. I had to ask myself, why is it that so many people are clearly content when their surroundings indicate they should be experiencing utter despair and even violent rage. Why is there kindness in their hearts and peace with their reality.

Photo of Coptic Youth, Egypt by Rudy Owens
These young men, all Copts, a persecuted minority, highlight for me the depth of goodness one finds in the world, even when many have no material foundation that suggests they should be happy.

I understood at all levels what I was experiencing. But Frankl’s framework ties this rich set of personal experiences to all of us, and to larger existential ideas of what we are meant to do with our time.

For Frankl, the answer is just doing what life needs us to do. As Frankl wrote nearly 70 years ago, “Life ultimately means taking responsibility to find the right answer to its problems and to fulfill the task which it constantly sets for each individual.”

With that point, I now must ask you, the reader, What are you doing with your life, and are you doing what you are being asked to do? You cannot escape this question, and if you avoid it, you will always have the pain and emptiness of not listening to your own calling. The choice of course is your own.

The crowded, congested, contested road: unsafe at nearly every speed

Seattle traffic
Seattle traffic is among the worst in the nation, and it can be downright deadly, according to those who track road-related fatalities.

Every day that I drive to work, I am literally putting my life on the line. I commute roughly 80 miles daily, round trip, from Seattle to Tacoma, navigating one of the most harrowing urban traffic corridors in the Untied States, on Interstate 5 and two state highways. (My story why I am commuting this way will be for another day, but there are good reasons.)

Routinely, erratic drivers dangerously pass me, putting our lives at risk, in order to gain a few extra minutes by speeding. I have seen many accidents, some fatal, on this route over the years, and I am glad that I have my will and living will in proper order in case a truck jack-knifes near me in the rain—and yes I’ve seen that happen twice before on the freeway system around Seattle.

Seattle Road Kill 2001-2009
How deadly are roads in the Puget Sound–take a look at the roadkill on this data map showing types of mortality by form of transportation for 2001-2009.

Judging by this map, we get a fair share of road kill in the metro area I call home.

The Centers for Disease Control and Prevention (CDC) put the number of road deaths annually in my home state at nearly 500 (2009). Nationally, in 2012, the United States reported that 34,080 people died in motor vehicle traffic crashes in 2012, a 5.3% jump over 2011. This ranks as 10th leading cause of death in the United States, if one pulls this form of death from all accidental deaths, in which it is grouped by the CDC epidemiologists.

So by all counts, getting in one’s car (or on one’s bike or in a bus or other form of transportation) and hitting the road can be deadly business in my country, especially given the proliferation of mobile-device users and drunk drivers.

In 2011, cell phone use in the good ole’ U.S.A. was a contributing factor in more than 3,300 deaths and for the previous year, in 387,000 motor vehicle injuries. These are very sobering numbers, and I actually expected there would be more given that I have seen far too many texters during peak travel times in vehicles moving 70 mph. Normally I move over a lane or lay on my horn to snap them out of it.

But this is nothing compared to the perils that passengers and drivers experience globally. According to the World Health Organization (WHO), road accidents claimed 1.2 million lives globally in 2011, ranking as the No. 10 cause of death, on a list that has some pretty nasty company, including respiratory infections (3.5 million), tuberculosis (1.3 million), and the big killer of children ages 0-5 years, diarrhea (2.5 million).

The Institute for Health Metrics produced this data table showing how road deaths globally compared to other causes of death (it's No. 10); go to: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-heatmap
The Institute for Health Metrics produced this data table showing how road injury globally compares to other burdens of disease (it is No. 10); go to: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-heatmap

A typical story that one sees with mind-numbing frequency overseas are bus collisions with motorcycles and motor scooters. This November 2012 story, 19-yr-olds crushed to death by bus, notes two aspiring young men were run over by an errant bus driver and dragged 40 feet in Chandigarh, India; the driver then fled the scene. Both of the men’s heads were crushed by the bus’s wheels.

I saw no less than three similar road maulings on the island of Java in 2009, when I visited Indonesia. That island, one of the most densely populated locations in the world, is overwhelmed with low-income and middle-income residents on  scooters competing for space with trucks and army of loosely and unregulated van taxis and buses.

Indonesians who use these highly efficient and inexpensive 100-125cc motor scooters are frequently killed on the island nation's infamously unsafe and crowded roads.
Indonesians who use these highly efficient and inexpensive 100-125cc motor scooters are frequently killed on the island nation’s infamously unsafe and crowded roads.

Road accidents alone in Indonesia account for more than 48,000 deaths annually, the 9th leading cause of death in the world’s largest Muslim nation.

The United States Department of State offers this stern warning to would-be American visitors to Indonesia–a country I really loved by the way: “Air, ferry, and road accidents resulting in fatalities, injuries, and significant damage are common. … While all forms of transportation are ostensibly regulated in Indonesia, oversight is spotty, equipment tends to be less well maintained than that operated in the United States, amenities do not typically meet Western standards, and rescue/emergency response is notably lacking.”

During my two-week visit in 2009 to the island nation, I rode about a dozen different buses and equally as many microbuses, not to mention the country’s crash-prone domestic air carriers once, their local train service (also unsafe at times), and the far less safe inter-island ferry services. I saw about a half dozen crashes from my bus window, most fatal and usually with motor cycle riders as victims, and from my hotel room I heard one multi-vehicle crash in the middle of the night that clearly claimed many lives. I learned the next day it was between a bus and truck. The bus was totaled.

Roads can really kill you overseas, and so can planes, boats, and trains too

Buses like these are cheap in Indonesia, but your life can be as some locals would say, insha-Allah, or at the mercy of God.
Buses like these are cheap in Indonesia, but your life can be as some locals would say, insha-Allah, or at the mercy of God.

The writer Carl Hoffman, author of the book The Lunatic Express: Discovering the World… via Its Most Dangerous Buses, Boats, Trains, and Planes, documents the horrendous conditions of ferries, public transportation, trains, planes, and other forms of transport. The book’s online promotion notes that it offers a “harrowing and insightful look at the world as it is, a planet full of hundreds of millions of people, mostly poor, on the move and seeking their fortunes.”

Anyone who has travelled in developing or “middle-income” countries (like, say, Chile or Turkey) knows their life is literally in the hands of drivers who may have no proper training, in busses with no proper maintenance or even reliable brakes. Worse, the drivers of buses and microbuses in countries from Uganda to India to Mexico may trust their fate to Allah, Saint Christopher, the Virgin Mary, or Krishna. Those who have travelled in such places know this to be true, by the many religious deities dangling at the front of public transportation by the drivers’ seats.

Worse, the drivers will often play chicken with their competitors by speeding into oncoming traffic at high speeds while passing other vehicles or simply to “have fun.” I swear I thought I would die on many occasions in: Mexico, Guatemala, Nepal, Peru, Uganda, Indonesia, Egypt, Turkey, Chile, Argentina, India, and other places that I’d rather forget just now.

accident or more by Birn
When is an accident really an accident, or when it is linked to larger systems issues? This analysis is provided by Anne-Emmanuelle Birn in her description of the social determinants of health (SDOH).

Three separate times, after I lived through the near mishap, I swore I would never, ever take a bus again in a developing nation. Yet I threw caution to the wind, as I needed to get around, and I could not afford to get around any other way. Not seeing the country I was visiting was not an option.

Is it really  “just an accident” or something more?

Anne-Emmanuelle Birn, international health professor at the University of Toronto, and co-author of the widely used global health tome called Textbook of International Health, points out the deeper connections that road-related deaths have to poverty and social inequity in undeveloped and middle-income countries. Birn writes that road traffic accidents are the second-leading cause of death for children between 5 and 14 years of age globally, and that poor and working classes are disproportionately affected in most countries. In high- income countries, most of those killed are drivers and passengers, whereas in low- and middle-income countries pedestrians, cyclists, and public transport passengers make up nine out of every 10 road-related deaths.

In Haiti, for instance, the word for local transport is molue (“moving morgue”) and in southern Nigeria locals say danfo (“flying coffins”).

Duncan Green, an Oxfam policy adviser and development blogger, recently wrote an article asking when road traffic injuries would finally be recognized as a priority by the international development community.

In fact a major report released in June 2013 by the Overseas Development Institute, the United Kingdom’s leading development think tank, notes that transportation is not recognized as a human right like access to water, yet it still is a fundamental factor for many to achieve basic human rights. Well-run transportation systems, for people and for goods and services, promote benefits, while unsafe and weak transportation systems harm the most vulnerable citizens.

Given the debate emerging now for future sustainable development post-2015, the deadline set for the Millennium Development Goals, road safety may finally find a way into the broader public health, development, and environment agenda, as a way to tackle this clearly documented major global killer. Perhaps the threat may finally be treated as the international epidemic that is is, globally or closer to home in the United Sates. For me, this includes the roads in the Puget Sound where I spend more than two hours daily to and from my public health job.