Courtney E. Martin

The Abstraction of Poverty Is Making Our Policies Poor

No ink has been spared and no caricature avoided as columnists and pundits have discussed the wealth stockpiled by GOP presidential frontrunner Mitt Romney.

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How to Make the World a Better Place Despite the Roadblocks and Naysayers

Adapted from  Do It Anyway: The New Generation of Activists, by Courtney E. Martin, Copyright © 2010. Excerpted with permission by Beacon Press.

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What Should a Feminist Man Look Like?

"Machismo!" shouted a young college student in the third row.

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A Powerful Movement Puts Mothers at the Helm of Social Change

The public image of motherhood has certainly gotten a political makeover in the past decade or so. What started with all that punditry about "soccer moms" and "security moms" as the voters du jour in the 2000 and 2004 elections got real with the March for Women's Lives, during which radical moms pushed strollers alongside the dykes on bikes. Then Code Pink emerged as an anti-war force led in large part by angry moms.

Today all the buzz is about "mommybloggers," an unfortunate name for an explosion in women writing online about not just diaper brands and nanny worries but public policy, military spending and a million other topics. A new anthology edited by one such "mommyblogger," Shari MacDonald Strong, is just out on Seal Press, appropriately titled The Maternal Is Political: Women Writers at the Intersection of Motherhood and Social Change. It documents this fascinating shift -- from June Cleaver to Cindy Sheehan -- through essays by some of our time's greatest writers and politicians, including Anna Quindlen, Anne Lamott, Barbara Kingsolver, Nancy Pelosi and others.

AlterNet caught up with Shari MacDonald Strong between family vacations and laptop explosions to find out what this radical mom learned from putting together such an exquisitely written and deeply felt collection.

Courtney E. Martin: The mothers' movement is referred to frequently in these beautiful essays. For those who aren't familiar, can you define exactly what the mothers' movement really is?

Shari MacDonald Strong: I don't know anyone who can, actually. That's one of the biggest challenges facing the movement.

Does a mothers' movement exist? Absolutely. The phrase refers to the fact that over the last decade in the U.S. there has been an increasingly active and passionate effort on the part of mother-centric political groups, and on the part of mothers as individuals and as a broad political demographic, to increase awareness about the importance of mothers' work and to fight for legislation and representation that accurately reflects the needs, values and priorities of mothers in our society. This movement is impossible to define, however, because there is no single political leader, no self-proclaimed "Leader of the Moms," who is calling the shots; there is no one political organization that is dictating exactly what the needs, values and priorities must be for mothers in our society.

As movements go, the mothers' movement is a complex one -- one that is bringing about vital change on many different fronts at once. It's not as targeted as, say, the suffrage or civil rights movements. Countless moms are fighting together to bring about change in such areas as paid sick leave, health care coverage for all children, paid family leave -- something provided by every developed nation in the world except the U.S. -- the provision of quality childcare, equal pay for equal work particularly as it relates to mothers.

At the same time, many other mothers view different issues as being just as important as, or even more important than, these. The mothers' movement assumes that mothers are intelligent and passionate and discerning enough to decide for themselves what is for them the top priority and what they are willing -- especially amid the unending demands for clean laundry, hot meals, etc. -- to expend the energy, and put in the time, to fight for.

CEM: In the introduction you write, "Mothers carry a heavy enough burden without being told we need to do more in the political realm." It reminded me of the Marxist idea that the proletariat -- the working class -- was somehow going to have the energy to rise up and start a revolution, when really, they were totally exhausted after a long day's work. Is the mothers' movement one more example of women taking on too much of the burden?

SMS: Absolutely, it is. And at the same time, who else is going to do it? We've been waiting a long time, for example, for our government to "get" -- and to do something about -- the fact that women still don't get paid equally for the same work as men. Mothers make even fewer pennies on the dollar than single women do, and for the same work -- and single moms make the least of all. Who's going to fight the battle to change this picture, if not moms? Who else is going to notice the problem? It goes back to that old Women's Studies 101 issue of power: It's not just that people with power don't want to give it up; they're often quite clueless about what life is like for those with less.

Putting all this work on mothers' shoulders is a burden. It would be much more fair if far more non-mothers joined us in the fight. To be fair, many non-mothers have, and hopefully, many more will. But until then, and even after that, as we moms say to one another time and time again: We do what we have to do, because it has to be done.

CEM: Another theme that I found throughout The Maternal is Political is the notion of self-respect. Marrit Ingman writes, "We need not apologize for our efforts to recover; when we struggle with the beast, we send our children messages of self-respect -- that we are people, and people matter." So often mothers are entirely focused on the welfare of others, neglecting themselves in the process. How is the mothers' movement encouraging women to value self-care?

SMS: First, at the bedrock of self-care are the issues of being seen and heard. These are two of the most basic needs, for any of us. And, of course, many of the political issues mothers fight for fall under the category of "self-care." Roughly half of all employees of private companies don't get any paid sick days; that number rises to 80 percent for workers in the service industry. How do you practice "self-care" when you're a mother with no paid sick days, and one or more children who inevitably, and on a regular basis -- surprise! -- get sick. Do you save up your sick days for yourself, save your sick days for your children's illnesses or send your children to school while sick so you don't risk losing your job? Obviously, no one should have to make choices like this, but mothers do make hard choices like these, every day. Some choices relate to sickness, some to child care, some to breast-feeding -- the list is endless. This lack of support leaves little room in mothers' lives for self-care. This is a significant piece of what we're fighting to change.

CEM: Tracy Thompson writes, "Becoming a mother made it clear to me that I had become a member of a boundary-free global statehood of women united by a profound common interest: the welfare of the next generation." Where are fathers in all of this? Why is it that mothers seem to feel this call, this sisterhood, but men are absent from the conversation in much of these pages?

SMS: I put this book together because I was longing to hear other mothers' voices speaking about motherhood and politics. I think that women and mothers have largely -- with a few exceptions, like attention paid to "soccer moms" or so-called "security moms" in recent elections -- been either ignored or underestimated in the political realm, and this felt like the most overlooked group of voices. But it's not the only overlooked group. You're right: Although men's voices have dominated politics for a long time, fatherhood rarely enters the political discussion. It dumbfounds me that politicians of both genders, who are also parents, don't speak more overtly about their politics as viewed through the lens of parenthood.

As much as I love this volume of stories about politics, written by mothers, I think a compilation of stories about politics, written by fathers from a father's perspective and not simply from a man's perspective, is just as needed and could be just as powerful and world-altering.

CEM: I was so moved by Violeta Garcia-Mendoza's essay about the personal and the political with regard to global adoption. She writes, "Adoptive motherhood bears the secret that the lines we erect to partition ourselves off from others, to protect ourselves against the heaviness of the human experience, are arbitrary." Do you see that maternal as inherently political, in part, because it provides us with an undeniable experience of our interconnection?

SMS: Absolutely. None of us lives in true isolation, much less parents in isolation. The struggles that you face, that I face, other families also face. No one is powerful enough -- or smart enough, and connected enough, etc. -- to single-handedly solve every problem that arises. Child care, health care, a sinking economy, national security -- if one of us could "fix" the problems, that person presumably would do so. But of course, it doesn't work that way. We need one another.

As a parent, I'm constantly interacting with people who are different from me, who cause me to step outside of my comfort zone. Some of these people, I enjoy immensely; others grate on my last nerve. In these cases, I suck it up and find a way to work with that teacher or that other parent, because that's what my child needs. That's what mothers do. It isn't about seizing an idea about how things should go and then sticking to it; it's about engaging with others, and questioning, and engaging again, and then re-engaging some more, and together doing whatever needs to be done to facilitate our children's well-being.

CEM: Most of the essays in the anthology are written from a left-leaning political point of view. Do you see room for conservative mothers in the mothers' movement, or is it limited to women who are pro-choice, Obama lovin', and likely to be driving hybrid cars? What about economic diversity -- do you see many women of low-income backgrounds getting involved in this burgeoning movement?

SMS: The book leans left, in large part because I do -- but the mothers' movement club isn't exclusive, and membership isn't limited. I do see the mothers' movement as being very progressive-driven, but it would be a mistake to think that only self-defined "liberal" moms are involved. Finding common ground often starts with thinking for ourselves and voting our consciences, instead of our parties.

As for lower-income mothers, there are many lower-income mothers who are doing some of the most vital work in the movement. But it's also unrealistic to expect that they can carry a large portion of the burden. Many are working multiple jobs, getting even less sleep than the rest of us other mothers, barely hanging on by a thread. Activism is both a basic, primary need and a luxury that not all of us can afford. The wisdom and insight and passion and hard work of lower-income mothers is something the mothers' movement needs, but these mothers' need for the passion and hard work and connections and string-pulling of those of us who have the often meager, but still-present energy to give it may be even greater.

CEM: How do you see mothers influencing the 2008 election?

SMS: I wonder sometimes which group(s) of mothers the candidates will identify and target this election season. "Soccer moms" and "security moms" have been courted in the past. The political pitches these mom-groups field are discouraging, precisely because they're so obviously manipulative. I can understand why a politician would want to identify a group s/he sees as being sympathetic to her or his political positions. But I get frustrated when I see the media getting on the sound-bite roller coaster. I don't want to see a bunch of news stories about "moms who care about national security" advertised this year. After all, what mom doesn't care about her kids being safe? Such angles are disingenuous, and they break us down into groups whose lines are arbitrary or don't even exist.

The reality is, the candidates are going to have to seriously address issues that moms care about, and the smart candidate will do so proactively and overtly, directing his comments to all mothers. Considering how tight the last couple of presidential races have been, I realize that, as a group, mothers could easily decide the 2008 election. The bigger question right now is, will the candidates take us as seriously as we deserve to be taken, address our concerns and give us solid, family-related reasons to get up and do it?

What Makes Female Suicide Bombers Different?

Last week four more Iraqi suicide bombers struck, leaving the mainstream media dumbfounded. Anchors from Atlanta to New York asked pundits: "What do you make of this?" "What could the motivation be?" "Who put them up to it?"

After five years of a war filled with attacks of this nature, you wouldn't expect the media to be so shocked and awed, but there was one critical factor that had the anchors stumbling: all four suicide bombers were female.

Female suicide bombers are, in fact, not a new phenomenon. According to Debra D. Zedalis, author of Female Suicide Bombers, the first known attack by a woman is traced back to 1985, when 16-year-old Khyadali Sana drove a truck into an Israeli Defense Force Convoy, killing two soldiers. Since then women from Sri Lanka, Chechnya, Palestine, Turkey, and Israel (among others) have participated in suicide bombings. In fact, the Tamil Tigers in Sri Lanka use women between 30 and 40 percent of the time when carrying out such attacks.

Starting in 2003, Iraq has experienced over 50 suicide bombings carried out by women, 20 of them just in the last year. It is no longer justifiable for the media to act aghast when another woman turns up with blood on her hands.

How could a woman do this? As doctoral student Lindesy O'Rourke argued in her New York Times op-ed last weekend, women appear to have the same motivations as their male counterparts -- as O'Rourke puts it, "a deep loyalty to their communities combined with a variety of personal grievances against enemy forces." Women, like men, have the capacity for ideological extremism and retaliatory violence.

A more important question is, what conditions make suicide bombing a viable option for human beings -- be they men or women? And, further, what is our role, as Americans, in perpetuating these conditions?

The majority of suicide attackers, of either gender, are young. CNN reports that the U.S. military has a 14-year-old would be suicide bomber in custody, indeed a woman. Averagely, they are in their early 20s, an age known for exploration and ideation.

These young people get pulled into nationalistic or ethnically-based organizations (no woman, to date, has been involved in an independent suicide attack) that promise them a way to make their lives meaningful. Many, though not all, of them come from economically depressed families, towns and cities ravaged by long and bloody war, and relationships that have left them psychologically vulnerable.

In one of the best investigations of female suicide bombers to date, journalist Jan Goodwin secured an interview with Liberation Tigers of Tamil Eelam (LTTE) failed suicide bomber Menake, currently awaiting sentencing in Sri Lankan prison. Menake's alcoholic, abusive father killed her mother when she was just three years old and brutally raped her at the age of seven. An excerpt from that interview, which appeared in Marie Claire magazine:
Menake wrote to the LTTE secretariat. "I'm willing to become a Black Tiger," she wrote. "It would be an honor. Please let me have your permission to join."

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Generation Y Refuses Race-Gender Dichotomy

I was born on the last hour of the last day of the last year of the '70s. So, like so many of my Generation Y peers, I was raised on Free to Be You and Me, hip hop, and feminism. I was 11 when Anita Hill changed the world and just about Monica Lewinsky's age when her blue dress dominated the headlines. So that just gives you some perspective on where young voters like me are coming from when we consider race and gender in the political environment, the topic of a panel I had the honor to speak on today at The Paley Center titled "From Soundbites to Solutions: Bias, Punditry, and the Press in the 2008 Election" (co-sponsored by The Women's Media Center, The White House Project, and The Maynard Institute for Journalism Education .

According to PBS News Hour, 5.7 million people under the age of 30 voted in the primaries, a 109 percent increase from the last presidential election. There's no question that young people are excited about this political moment; there's no question that we care deeply about issues of race, gender, class, and religion; we are not, however, endeared to partisanship. Chalk it up to Facebook, competitive college admissions, or all of the other phenomena that influence us to see ourselves as individual project, but it's clear that we resist groupthink. We shy away from taking on any sort of movement identity, preferring to vote for the individual candidate and his or her policies, and preferring to be seen as individual people -- not a texting, IM-ing mass of technologically superior and socially inferior sons and daughters. As my peer Keli Goff put it in her wonderful book of the same name, we're into "party crashing."

When we do take the leap to identify with a movement, as I have in the case of feminism, we still seem to buck against the idea that our affiliation determines our vote. I, for example, am an Obama voter, but was and will continue to be an avid Clinton supporter. I hate the sexist coverage that she endured, and have written and spoken out about it widely, but that doesn't change my vote. My feminism is not just about gender equality in government, but also about racial justice, global security, community ethics, etc., and I resent being made to feel as if there is a "right" way to vote if I am a feminist. I'm grateful for being challenged to justify my choice to pull the lever for Obama by feminist friends and mentors, but only when it's initiated in the spirit of dialogue, not a litmus test.

Our tendency towards thinking and acting solo isn't such a surprise when you consider the ethnic and cultural origins of this generation. The country is becoming more and more interracial, thanks to the increasing incidence of interracial pairings like Obama's parents, as pointed out by public education projects like Loving Day. And further, genealogy and genetic efforts like Henry Louis Gates Jr.'s The Root are pointing out that even before interracial unions had been destigmatized (at least in urban centers), plenty of our ancestors were crossing the color line behind bedroom doors. It's not so strange these days to meet a Chinese-Chilean guy living in Brooklyn or a Vietnamese Baptist in Houston. How could we affiliate with one party/movement/organization when we contain such a multitude of loyalties in our own little legacies?

The million-dollar question: How, with a generation bent on individuality and multiplicity, do we confront racism, sexism and all the other insipid -isms that have been brought to light by this unprecedented campaign? To my mind, we must continue to use novel interventions -- like the Women's Media Center's great montage "Sexism Sells, but We're Not Buying It," the brand-new blog Michelle Obama Watch, and the evergreen experts at Racialicious -- to educate people. We must use humor -- as my group blog Feministing often does, as the brilliant Sarah Haskins does on Current TV, as Ann Telnaes does through cartooning over at Women's eNews. (Note: It's not just the boys -- John Stewart, Stephen Colbert, and the Onion crew -- that know the power of a laugh.)

We must take our roles as media consumers dead seriously, calling television executives and newspaper editors on their misguided choices and celebrating them when they get it right. In an increasingly corporatized media landscape, it is your dollar, not your disgust, that will most readily get big-wig attention. Don't buy sexist magazines, don't tune into to racist radio, and don't watch reductive, recycled infotainment being pawned off as news.

But most of all, it seems to me, we must continue to push for a deeper, more authentic conversation overall. We must let the mainstream media know that we don't want to debate "reject" or "denounce" for 24 hours or go on witch hunts for Geraldine Ferraro or Samantha Power. We want to understand what these women were trying to say. We want to explore the real issues. We want to, as my co-panelist Juan Gonzalez of Democracy Now so brilliantly put it, call into question the whole idea of empire. The debate shouldn't center on the quandary: How can we make our empire more effective? But, do we want to be an empire in the first place?

And we must demand that our candidates rise to the occasion, as I believe Obama did so beautifully with his speech on race following the Reverend Wright controversy. He brought that conversation to a new level, and we are all better off for it. We need to continue to push for that kind of brazen truth-telling -- about gender, certainly, about class, for sure. That's what politics is supposed to be about -- not partisanship or strategic spinning, but honesty and uplift. Call me naïve, but that's what the young are supposed to be, right?

Admitting the Complexities of Abortion

Planned Parenthood was packed on a Thursday in the frigid Colorado dead of winter. I remember giving up my seat to a woman who looked to be in her thirties and totally unfazed by the crowded lobby on abortion day. She alternated between gabbing on her phone and yelling at her toddler. I flipped through a magazine without really looking at the pages and hated her a little.

It wasn't that I thought she was an evil person. I am not, nor ever was, a conservative Christian -- despite having grown up just miles away from Focus on the Family. In fact, I was at that Planned Parenthood, in order to support a pregnant neighbor. After a condom-break and twist of fate, she was too scared to tell her parents, but too determined to protect her own future. We marched past the pro-lifers with their gruesome placards and went inside, arm in arm.

I was unequivocally pro-choice, but I hated that woman in her 30s because she seemed (I didn't ask) to have such an uncomplicated relationship with abortion. I was jealous. Past my conviction that abortion should be legal and safe, my own feelings were a mess.

I felt that way again at a screening of Jennifer Baumgardner and Gillian Aldrich's film, I Had an Abortion, a couple of years ago. After a riveting film collage of real women who had experienced the complexity and power of abortion, a rather one dimensional discussion took place where older feminists expressed their disappointment in younger women's ambivalence over the issue. A young woman spoke about her conviction that abortion should be legal, but not easy, and another woman, who looked to be in her 50s, immediately yelled out "Abortion is a form of contraception!" Another feminist veteran teared up talking about her misguided students who expressed shame over abortion, but there was a hint of patronizing mixed in with the sadness.

The truth is that my generation (Gen Y, Third Wave, whatever you want to call us) doesn't have the black and white zeal of second-wavers when it comes to abortion. Some of my friends believe that abortion should absolutely be legal, but that they, themselves, would not get one. Some of my friends have already had them; they don't regret it, but a few have seen therapists and healers afterward, aching to make peace with their decisions. I've had heart-to-hearts with many a guy friend trying to support his significant other through an abortion and feeling inadequate and confused.

I see abortion as a very grave and complicated personal decision, and one that every woman is entitled to make for herself. Even though I am pro-choice, I am pro-admitting the complexity of that choice. The fact that so many older feminists are unwilling to even entertain my generation's ambivalence over the psychological or even spiritual implications only serves to squash potential dialogue.

As we celebrate the 35th anniversary of Roe vs. Wade this week, I hope we can remember a bit of the spirit at the Women's March for Choice in Washington, D.C. -- a gathering of over a million people according to some estimates -- back in 2004. Surrounded by men, women and children of all ages, I felt empowered to stand up for every woman's legal right to reproductive choice (not to mention health), but also free to disclose my complicated feelings over the issue. There was space for transformational dialogue as we lay in the grass, listening to the diverse speakers. There was time to look women of all ages in the eyes and say, "This is where I'm coming from. How about you?"

Too often women's studies academics and veteran feminists end up preaching to the choir, cutting off contention, being exclusive with their language. I have sometimes felt like I would be disrespecting my legacy, or worse, personally offending various older feminists that I have deep respect for, if I initiated a conversation about abortion that didn't stick to the movement tag line. Does it really weaken the argument that it should be legal, just because we admit it is also fraught? Divorce is legal and it can cause depression, regret, and animosity; it can also free women up to fulfill their potential, live their fullest lives, have some control over their fate. No one would ever claim that it was unfeminist to acknowledge these potential complications.

I recently taught Introduction to Gender Studies at Hunter College, an affordable city school in New York City with a great reputation, largely populated by recent immigrants or first-generation Americans. In one of my small, discussion courses, a young, working class woman from Far Rockaway raised her hand and said, "I always try to avoid saying this in my women's studies classes because I am afraid I'll get beaten up, but I kinda think abortion is bad."

I urged her to feel free to speak her mind, that this, in fact, was the point of coming together in learning communities. And she did. And, yes, sometimes it made my skin crawl, especially when she said that she "understood how people could want to bomb abortion clinics." Perhaps I experienced a bit of what some older feminists feel when a young woman in their midst wants abortions to be "safe and rare" or expresses concern over its mental health effects. Belief exists, after all, on a spectrum.

It wasn't comfortable for me to listen to that student's opinions, but it was necessary. We created a space where people of very different religious and moral persuasions came together and had a really tough conversation. Pro-choice -- as a stance -- had been personalized for my student; she liked me, how could she ever again hate or advocate violence against "my kind?" (I've known, and am even related to, many a pro-lifer, so that wasn't a new experience for me).

None of us changed our minds, but we left enriched, informed, and, most critically, fully owning our ideas. This respectful exploration, not the intimidating zealousness of some pro-choice veterans, is the ultimate aim of feminism.

How to Address Obesity in a Fat-Phobic Society

A friend of mine -- I'll call her Ellen -- recently went to her regular medical clinic after realizing that she was newly suffering from an old family problem: acid reflux. Her doctor was out on maternity leave, so she met with a replacement. Without asking Ellen any questions about her relationship to her weight (she is overweight and well aware of it), he launched into a robotic exposition about dieting.

Ellen explained to him that she worked out regularly and also did her best to eat healthy, but had a philosophical problem with turning food into the enemy. He simply retorted: "The only way you're going to lose weight is to cut the carbs. So ... cut the carbs."

"When he brought up my weight I wanted to have a real conversation with him, but instead he gave me his version of my 'problem'," Ellen said. "It made me really angry."

My friend's experience is not an anomaly. In fact, it is representative of a still unchanged attitude among too many medical doctors and nutritionists that fat people are problems to be solved; if they can just come up with the perfect equation, they figure, BMIs can be lowered and the supposed obesity epidemic eradicated.

This attitude shows up in doctor's offices where overweight and obese patients are often subjected to inquisition-like questioning. Yet they are rarely asked other, arguably more important questions: What's your experience of your body? How is your quality of life? How do you feel about your weight?

It also shows up in obesity intervention programs throughout the country, where a person's culture, class, education, or even genetics, are overlooked in the dogged pursuit to motivate what too many clinicians see as "lazy Americans" to lose pounds.
It's not as if we don't have the evidence that these factors -- culture, class, education, genetics -- matter. Yet another study just came out by University of Washington researchers who found gaping disparities in obesity rates among ZIP codes in the Seattle area. Every $100,000 in median home value for a ZIP code corresponded with a 2 percent drop in obesity.

Adam Drewnowski, director of the UW Center for Obesity Research, told the Seattle Post-Intelligencer,"If you have this mind-set that obesity has to do with the individual alone, then ZIP codes or areas really should not come into this. But they do, big-time."

This is not to say that individual behavior doesn't play a vital role in our country's obesity rate, but we too often neglect to think about the cultural and institutional influences on a person's behavior when it comes to eating and exercise.

You would never look at a working class, single mother driving a jalopy with three kids crawling around in the back and say, "Gees, what's her problem? Why can't she drive the Lexus hybrid like me?" You understand that she doesn't have the means, and furthermore, probably doesn't have the peer influence that would make it seem like a viable option.

Our judgmental, fat-phobic society seems even more ridiculous when you consider that there is a strong genetic component to weight. We now have ample scientific evidence suggesting that we are each born with a set point within which our metabolism will automatically adjust no matter how many calories we consume. It's like our working class mom could be dedicatedly saving up for that hybrid, but the money just keeps disappearing from her bank account.

Instead of vilifying fat people, this country needs to look long and hard at the roots of our obesity epidemic. While we can't change someone's genetics, we can work to change the institutional disparities that make maintaining a healthy weight difficult for people with less money. Encouraging supermarkets to open up in poor neighborhoods by adjusting zoning laws and creating tax-incentive programs is a start. More funding for public schools in low-income areas would translate into better quality food in the cafeterias and more nutrition and physical education.

In addition to addressing these classist systems, we need to do some soul searching about our own attitudes about fat. Until those of us who care about public health can truly separate the potential health risks of being overweight from our own internalized stigmas about fat, we won't be effective. We have to learn to distinguish between those who are satisfied with their current body size and those who wants to lose weight, and then, learn to provide complex guidance that takes societal and genetic factors into account.

Those in the field of public health need to remember how motivation really works (hint: not by coercion or humiliation) and rethink how quality of life is measured when it comes to overweight patients. It is not the clinician's -- often prejudiced, frequently rushed -- point of view that matters most, but the individual's.

Dr. Janell Mensinger, the Director of the Clinical Research Unit at The Reading Hospital & Medical Center, also recommends shifting the goals of obesity intervention programs: "Focusing on health indicators such as blood pressure, cholesterol, blood sugar would serve to de-stigmatize obese individuals and help them engage in better eating habits and physical activity for the purpose of healthier living as opposed to simply being thinner. Although I see some programs shifting in this direction, I don't think they have gone far enough."

Mensinger adds, "We have to avoid promoting the dieting mentality! Encourage acceptance of all shapes and sizes while promoting the importance of physical activity and eating well for the purpose of living and feeling better, mentally and physically. The people that most successfully achieve this goal are those with an expertise in eating disorders as well as obesity. They know best what can happen if the message is misconstrued."

Whether you are a primary care provider, a nurse practitioner, a nutritionist, or a community health advocate, I urge you to treat your next patient like a living, breathing human being with complicated feelings, economic concerns, and cultural affiliations. Weight loss isn't the ultimate goal; economic equality, cultural diversity, wellness and happiness are.

Rethinking Antidepressants and Youth Suicide

Rosa Rodriguez,* now a college student, recalls her suicide attempt at 13 years old: "I decided I couldn't take it anymore, so I took some pills and went to bed early. I threw it all up within 20 minutes, and thinking back, I'm glad it didn't work out."

She goes on: "I share my bed with my sister, and it would have been really selfish of me if I did that knowing that she was lying next to me. I obviously wasn't thinking rationally."

While Rosa looks back with remorse, she does not look back with confusion. She has continued to struggle with depression throughout her life, a disease that affects 5 percent of adolescents and children. According to the Centers for Disease Control (CDC), 90 percent of those who attempt suicide have a significant psychiatric disease. Rosa is not an anomaly.

Two new studies confirm that the suicide rate among young people has increased, particularly among girls between the ages of 10 and 14. The numbers have researchers, health advocates, parents, educators, and teens debating the potential causes -- the most controversial of which is the corresponding drop in antidepressant use among youth after U.S. Food and Drug Administration (FDA) warnings in early 2003.

The first study, conducted by the CDC's National Center for Injury Prevention and Control confirms that between 2003 and 2004, the suicide rate among children and young adults rose 8 percent; the suicide rate for girls ages 10-14 jumped 76 percent. CDC researchers are quick to point out that, though they are interested in the corresponding drop in antidepressant use, the study doesn't prove a causal relationship.

Robert Gibbons of the University of Illinois at Chicago, the head researcher on the other study, believes he has that proof. His study, published in the American Journal of Psychiatry, found that the youth suicide rates in the United States rose 14 percent between 2003 and 2004 and 49 percent in the Netherlands. Youth antidepressant prescriptions fell 22 percent among children aged 0 to 19 in both the United States and the Netherlands after the 2003 warnings were issued.

The study, however, has come under scrutiny recently because two of its eight authors, including Gibbons, have ties to big pharma. Gibbons once served as an expert witness for Wyeth, maker of Effexor; J. John Mann, a neuroscience professor at Columbia University, has received research funding from GlaxoSmithKline, creator of Paxil, and has been an adviser to Eli Lilly, which sells Prozac.

Still, these conflicts of interest do not necessarily mean the study's conclusions are wrong. Any way you slice it, these numbers are alarming and worth a closer look. Especially when you consider that prior to 2003, the suicide rate among youth aged 10 to 24 had fallen by 28.5 percent over a 13-year period. Dr. Ileana Arias, director of the National Center for Injury Prevention and Control told reporters: "We don't yet know if this is a short-lived increase or if it's the beginning of a trend."

Rethinking antidepressants
Though the FDA has never approved Zoloft, Paxil or most similar drugs (with the notable exception of Prozac) for use by younger patients with depression, many doctors prescribe them. According to the Journal of the American Academy of Child and Adolescent Psychiatry approximately 1.4 million pediatric patients are currently taking antidepressants.

In the FDA review, no completed suicides occurred among nearly 2,200 children treated with selective serotonin reuptake inhibitor (SSRI) medications. However, about 4 percent of those on the drugs experienced suicidal thinking or behavior, including suicide attempts -- twice the rate of those taking the placebo.

In 2003, following this review and lengthy hearings, the FDA issued a warning that the use of antidepressants -- particularly the very popular SSRI type, including Prozac and Paxil -- could increase the chances of suicidal thoughts or actions in children and teenagers. The warnings were added in a "black box" on the medications in October 2004.

The FDA posted a revised warning on its website on Feb. 3, 2005, changing the wording to say only that the drugs "increased the risk of suicidal thinking and behavior in short-term studies of adolescents and children" with depression and other psychiatric disorders.

This significant change came after several months of aggressive lobbying by the pharmaceutical industry, a fact that remains in many health and consumer advocate's minds.

Vera Hassner Sharav, for example, president of the Alliance for Human Research Protection, testified in many of the original FDA hearings and is not convinced that the new studies point to antidepressants' ultimate safety. As she told NPR: "You cannot determine a causal affect because you're not looking at other circumstances."

She suggests that other factors, like the use of antipsychotic drugs, could also be affecting the spike in the suicide rate. Sharav is concerned that news of these studies will give consumers the spurious idea that antidepressants are, indeed, no longer potentially dangerous for children and teens.

But other experts, while saddened by the rise in the suicide rate, are heartened by evidence that antidepressants really do have the potential to save children and teen lives.

Dr. Benjamin Shain, co-author of a clinical report on teen suicide by the American Academy of Pediatrics, explains, "There is no treatment that is 'safe,' as even talk psychotherapy, another important treatment for depression, has risk. The risk of serious side effects from antidepressant medications, however, is low and must be balanced against the risk of inadequate treatment of depression: lower grades, difficulty with relationships with family members and friends, loss of ability to have fun and enjoyment, and just general misery, as well as a much higher risk for suicide."

Dr. Brad Sachs, a psychologist specializing in clinical work with children, adolescents and their families, explains, "When it comes to treating childhood and adolescent depression, clinicians should leave no stone unturned, and that includes the possible use of antidepressant medication. There is no question that antidepressant medication has relieved the unnecessary suffering of numerous children and adolescents, and has saved lives in the process."

From Sachs' perspective, however, writing a prescription for an adolescent to take antidepressants is never a simple matter. For starters, many of the newer medications have not been studied longitudinally, so we don't yet know about the long-term impact. Second, children and adolescents have been known to misuse medication. And, as Sachs explains: "In addition to whatever physical side effects these medications stimulate, there are also nonphysical side effects, such as conveying the unfortunate message that all of one's problems can be solved by 'taking a pill.'"

Demographic shifts
These findings raise many new questions: the most urgent of which is, Why the rise in suicide among young women, and particularly among such young women (aged 10-14)?

Patti Binder, who has worked with girls from this age group for over seven years in various nonprofit capacities and blogs at What's Good for Girls, has a hypothesis: "Middle school girls are not ready for adult pressures, including those that come with the sexualization of girls that we are seeing today." She refers to the American Psychological Association's 2007 Task Force on the Sexualization of Girls, which found that increased pressures to appear and act in a sexually explicit way at a younger age were linked to mental health disturbances in teen girls. Mental health disturbances, of course, are linked to suicide.

Dr. Roni Cohen-Sandler, psychologist and author of Stressed out Girls: Helping Them Thrive in the Age of Pressure, also believes that there is an important link between the pressure girls face and the rising suicide rate: "I am seeing an increase in such desperation among young teens. There are more mixed messages in this culture, fewer opportunities to conform to societal ideas of success, and sometimes a lack of support in families, which are experiencing increased stress and dissolution."

The rise in suicides among tween, or pre-teen, girls may also have something to do with weight issues, some experts speculate. Abby Ellin, health writer for the New York Times, reports that the single group of teenagers most likely to consider suicide are girls who think they are overweight. In a recent study of 11,000 American adolescents by UT sociology professor Robert Crosnoe, for example, he found that obese girls often engage in negative behavior to cope with isolation and social stigmatization, like skipping school, using alcohol or drugs and considering suicide.

Eating disorders, such as bulimia and anorexia, also on the rise among tween girls, may be contributing as well. Shain stresses the need for more research in this area, but points out that the malnutrition associated particularly with anorexia typically leads to depression.

Looking towards healing
The spike and demographic shifts are motivating those in the long-established field of suicide prevention to rethink some of their strategies, but they are also adamant that the public not overgeneralize based on these new numbers.

Chris Gandin Le, an expert on suicide prevention and technology, explains: "Suicide is complicated by cultural factors and outside influences, but it is such an individual decision."

Thanks to the Garrett Lee Smith Memorial Act, passed in 2004, more money is being spent on suicide prevention -- particularly among teens -- than ever before. Gandin Le is hearted by the efforts he sees to incorporate social networking sites, like Facebook and MySpace, into the widening and varying approaches to keeping kids aware that they have options.

He also points out that progress is being made with regards to "postvention" -- intervention efforts into communities, both physical and virtual, to prevent suicide clusters (the devastating phenomenon where multiple suicide attempts or deaths follow an initial loss.)

In 2004, about 161,000 youth and young adults between 10 and 24 received medical care for self-inflicted injuries in hospital emergency rooms across the nation, proving further that being aware of the warning signs for child/teen depression is critical.

Sachs sums up the task ahead: "When we shrink and distill our conversation regarding adolescent depression and suicidality down to whether or not to prescribe medication, or which medications to prescribe, we miss a crucial opportunity to examine and evaluate our collective priorities, and to perhaps begin redesigning them so that not only adolescents, but adults as well, discover new ways, or rediscover old ways, to bond, care, grow and heal."

*Indicates a pseudonym.


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