04 April 2012

The Two Most Dangerous Six Months Of Your Life

There are two six month periods in your life where your risk of death are extremely high. Greater than the risk of death of an active duty Army soldier or Marine during a war. At least comparable to the risk associated with being someone who rides a motorcycle for long distances on a daily basis. On a par with driving a just above the legal limit for drunk driving every weekend. Comparable on a per day basis to playing golf on hilly treeless golf courses during lightning storms. More dangerous than being a beat cop in a high crime neighborhood, or working on a fire crew against a wildfire.

If you are reading this post, you survived on of them, the first six months of your life, when there are a large number of deaths in connection with child birth, from congenital abnormalities, and from the fragilities of infancy that open the door to causes of death like sudden infant death syndrome. Parents with newborns are also the least expert in caring for them and are prone to engaging in child abuse or child neglect flowing from frustration with not knowing how to handle a newborn, hence you see things like instances of shaken baby syndrome when a new parent doesn't stop crying and a new parent doesn't emotionally as well as intellectually know better, or instances of an infant being left alone in a situation where the infant shouldn't be left alone because the new parent hasn't fully assimilated the idea that infants require almost constant attention.

The other most dangerous six months of your life is the six month period after your spouse dies. Surviving spouses have a greatly elevated risk of death. Part of this is random chance. New widows and widowers are much older than the general population and being old increases your risk of death. But there is more to it.

The death of a spouse is the most stressful event, by a huge margin, on scale established to measure the statistical impact of stressful events on the odds that you will get sick. The loss of a spouse is immune system suppressing.

The grief associated with the death of a spouse so routinely causes systems that would otherwise be consider clinical depression calling for professional treatment that a proposal to remove a "grief exception" from the diagnostic criteria for clinical depression is a controversial one. Those arguing for the elimination argue that the symptoms are the same and the evidence suggests that grief related unipolar depression responds to depression treatments in pretty much the same way that other unipolar depression episodes do. Those arguing against this historical exception (which was not made based on empirical studies), argue that the DSM-5 is trying to capture mental health conditions that are pathological and that such a natural and common place human response to a death is not a pathology.

There are a lot of ways that the depression of grief can cause death that aren't listed as suicide (or "heart break") on a death certificate but can being the moral equivalent of the same thing. Someone can "accidentally" take too much of a prescribed, or non-prescribed prescription drug. Someone can be indifferent to and careless to basic safe care measures from taking life preserving drugs to driving carefully to evaluating risks of accidents in daily life appropriately. One can abandon the attitude of a commitment to survive that seems to be part of the mind-body system that keeps the body focused on actively making immune and physiological efforts to fight off pathogens and maintain the functioning of moving parts like hearts and lungs necessary for the sustainance of life.

The United Kingdom and a lot of other places more enlightened than the United States recognize the vulnerability of newborn infants and provide for all new mothers and their infants to automatically receive nurse visits during that time period, something that has been shown empirically to significantly mitigate the risk of infant mortality, neglect and abuse in this special time which is much more dangerous than most people realize. If U.S. jurisdictions did the same, it would be a major step forward in public health in the United States.

It would also make a great deal of sense for there to be automatic and pro-active supportive intervention for people experiencing extreme grief events like the loss of a spouse or the loss of a child. The ordinary assumption that people will carry on as usually without the help of others at these times the way adults in ordinary circumstances do is not well founded in these situations.

Historically, this has been done through a variety of community norms and traditions. Families gather together and spend additional time together and often rearrange their lives to facilitate providing extra support to someone who has suffered a great loss. Friends and neighbors bring food without being asked. Anyone in the community who knows expresses sympathy and gives the grieving person slack. Employers make allowances and permit time off. Airlines cut people breaks on airfares. When someone dies abroad, the State Department routinely deploys a junior diplomat to assist the bereaved. Churches get whole communities of people who knew the deceased and the survivors together for memorial services and wakes and viewing and receptions to help them support each other. Even financial institutions and the legal system put in place rituals and routines in which professionals who deal with these situations routinely and are trained in how to do so ethically are on hand to facilitate the process of dealing with a death.

But, tradition and community norms are in flux, extended family ties have grown weaker while families have grown smaller, and even nuclear families are more geographically far flung in many instances. Fewer people are actively involved in churches or any form of civic involvement that provides regular, in person time with other people. So, maybe we must devise a better formal safety net as the informal one has frayed.

1 comment:

Dave Barnes said...

So, having survived my first 6 months and having a healthy spouse, I can drink heavily and drive.
I like that.