The capacities that people need in order to operate as free adults develop when we are small. The skills that we will apply to become unique human beings are created during the first five years of life, as the brain grows to nearly its full size. As infants and toddlers interact with other people, will and speech and thought emerge. We learn as very small children, if we ever learn, to recover from disappointment and to delay pleasure. Abundant research shows what allows these capacities to develop: relationships, play, and choices.
To be free involves having a sense of one’s own interests and of what one needs to fulfill them. Thinking about the constraints of life under pressure requires an ability to experience, name, and regulate emotions. Freedom has to do with choice, but we can only choose among options we see. When we are trapped in fear we see everything in binary terms: us or them, fight or flight. Children who learn to name and regulate their emotions have a greater chance of opening up space for positive feelings, even at moments of stress. Without those positive emotions we are less free, because we cannot see the various escapes and innovations that we might need at a moment of danger, or use to thrive and prosper at better times.
The paradox of freedom is that no one is free without help. Freedom might be solitary, but freedom requires solidarity. An adult who has learned to be free in solitude benefited from solidarity as a child. Freedom is thus a loan paid out and paid back over generations. Children need intense and thoughtful attention during those first five years. This special time cannot be given by children to children, nor by adults to adults. Children can only borrow this special kind of time from adults. They can pay back the loan only later, when they themselves are grown, to the children who are yet to come. A free country thrives over generations.
As anyone who has tried to raise children in America knows, time is very hard to come by. It is easy to say that children need trusting relationships, unstructured play, and activities that encourage choices. Say it out loud to an American parent and expect a patient smile, in the best case. How is this time to be found when parents work? We know the answer. Mothers should have four days in maternity wards after birth, as a matter of law. Both parents need substantial maternity or paternity leave, predictable scheduling at work, paid sick days, public childcare, and paid vacations. These things are normal elsewhere and possible here.
Mothers and families also need calm during life’s difficult passages, of which the bearing and rearing of children is one. Families who can count on good public schools for their children and reliable pensions for themselves will be less anxious about life and more available for their young children. If parents and caretakers know that they and their children have a right to health care, they will have more of the time and patience that they need to help their children become free.
LESSON 3.
The truth will set us free.
After my appendectomy on December 15th, 2019, I found myself identifying with others in a strangely intense way. Although no one had told me so, my liver was infected. Weakness brought me closer to people, made me more open to their stories. I paid attention to things I might have overlooked, like the words in front of churches as Christmas drew near. An announcement board in downtown New Haven asked whether “this Christmas we mean to celebrate one migrant family and separate, detain and deport the rest.” That summoned the story of Mary and Joseph and the difficult journey of a pregnant woman who gave birth far from home. The comparison of their plight to that of the undocumented migrants in nearby detention centers hit me harder than I would have expected.
The surgeon who had performed my appendectomy told me that it was safe to travel, so I went to Florida to join my extended family for a long-planned Christmas vacation. The idea was that I would recuperate on the beach. Matters took a different turn. I was hospitalized in Florida on the morning of December 23rd after my limbs began to tingle, but was discharged the next day with no diagnosis. I fell into a malaise on Christmas Day that worsened on the twenty-sixth and twenty-seventh. I began to lightly hallucinate, recognizing people I knew in the faces of strangers. Passersby began to resemble my brothers. My wife, Marci, got me and our children back to Connecticut on the night of December 28th. It was an unpleasant flight.
After those seventeen hours in the emergency room of a New Haven hospital in that yellow-curtained alcove on December 29th, and after a procedure on my liver, I was admitted to the room where I spent the last days of the year and the first days of the new one raging and contemplating. I shared that room with a Chinese man who was suffering from a number of afflictions. He spoke two words of English when I arrived and four when I left, and so doctors and nurses communicated with him through a translation service or with the help of his family. This meant that a great deal of personal and medical information was communicated loudly, slowly, and repeatedly.
I came to understand that my neighbor was fourteen years older than I, that he worked as a busboy, that he spoke Cantonese rather than Mandarin, and that he was in withdrawal from nicotine and alcohol after five decades of daily smoking and drinking. That last fact made me all the more appreciative of his friendly demeanor and gracious attitude. When he saw me taking walks, he realized that he could do the same, and always smiled in greeting when we crossed paths in the hallway. He wore headphones when he watched television and tried not to awaken me when I slept.
My roommate arrived on New Year’s Day, not long after returning from China, the day after authorities in that country confirmed the existence of a novel coronavirus. I soon developed a mysterious respiratory problem. I could not inhale deeply, and found it difficult to talk. My friends and family were troubled that I could speak by telephone for only a few minutes without seeming weary and losing my voice. Scans showed that both of my lungs had partially collapsed. At the time, doctors suggested that my right lung was compressed by the liver inflammation. But my scans actually revealed that my left lung had collapsed more severely than my right.
Like me, my roommate had respiratory issues but got over them, and was in the hospital for other reasons. Sharing close quarters with him, I couldn’t help but observe how he was treated and how his symptoms were evaluated. I was drawn into his story. Blood tests pointed in a number of directions. A parasite from raw fish eaten during his visit to China seemed the likely culprit. When cancer was ruled out, it was my first happy moment in the hospital. When I was discharged I gave him my good wishes through a friend who wrote them as a text message in Mandarin; he wrote a very kind response and had his phone translate it for me. “You too please take care of yourself well.”
* * *
My roommate was an example of two ways medicine can get to truth. Sometimes treatment is a matter of thinking along with the patient, focusing on a story, and making sense of it. I could hear his story coming together for the doctors, who perhaps paid more attention and remembered better as a result of the effort it took to communicate. Sometimes medicine is a matter of tests, a search for information by experimental means. This, too, was important for my neighbor. Although the doctors and nurses could not communicate with him directly, they did know which tests to run for which symptoms, and how to interpret the results. Within the limits of their clinical knowledge and the available tests, they could pin down what he did and did not have.