Harold and Maude

 

https://www.youtube.com/watch?v=-L0dIOxLhbk

With this month’s 50^th anniversary of Harold and Maude (1971) and announcement of the upcoming film soundtrack release by Cat Stevens/Yusuf, I decided to revisit Harold and Maude through clinical social work lens.  

“Clinical social work is a specialty practice area of social work which focuses on the assessment, diagnosis, treatment, and prevention of mental illness, emotional, and other behavioral disturbances.” –National Association of Social Workers 

Hey, what about focus on whole person in environment?! Though my job description involves clinical social work, I continue to view myself foremost as a gerontologist working with older clients (and their families/significant others) to understand what’s important for their quality of life and helping them navigate the dysfunctional long-term care system.  

As a first year MSW student (back in pre-pandemic times), I chose Harold and Maude, a funny and touching film celebrating an intergenerational relationship, in a DSM (Diagnostic and Statistical Manual of Mental Disorders) course assignment to conduct a biopsychosocial analysis of a film character. This clinical lens nearly ruined my film watching experience, but I will not let clinical social work ruin my affinity for working with older adults!!!

Harold and Maude:  Clinical Analysis of Harold and his Mother

Based on the character/characters, provide a biopsychosocial analysis of the character/characters of the film you chose.

            Harold and Maude showed only a week in the life of Harold, revealing little information about his earlier life, and even less about Harold’s mother, Mrs. Chasen.  My analysis will focus mostly on Harold, and a bit about his mother who was influential in Harold’s development before he met Maude.

A.    What is the diagnosis of the main character/characters and what type of symptomatology was present that led you to come to this assessment? When coding the diagnosis, use the ICD-10 coding. If there was not a diagnosis, you can use a provisional diagnosis and explain why you chose a provisional.   

            Prior to meeting Maude, Harold’s diagnosis appeared to be other specified depressive disorder, depressive episode with insufficient symptoms (F32.8), as indicated by his depressed affect and at least one of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persisted for at least two weeks: recurrent thoughts of death (American Psychiatric Association, 2013, pp. 183-184).  Harold appeared obsessed with death – attending funerals of strangers, driving a hearse, and staging at least 15 suicides.

            Harold’s domineering socialite mother, Mrs. Chasen, appeared to have a diagnosis of narcissistic personality disorder (F60.81), as indicated by her pervasive pattern of grandiosity, need for admiration, and lack of empathy; she had a grandiose sense of self-importance, believing that she is superior and should associate with other high-status people, had a sense of entitlement, lacked empathy, and showed arrogant behaviors or attitudes (American Psychiatric Association, 2013, pp. 669-670).  She appeared mostly insensitive to the needs of her son, responding to his staged suicides with indifference, like rolling her eyes while swimming past Harold when he was floating face down in their pool, and remarks such as “be a little more vivacious” when Harold was gagging with a noose around his neck hanging from the ceiling in their home.  She appeared self-absorbed with social events and maintaining social status, including controlling her son’s.  After finding a computer dating service that “screens out the fat and ugly, so it’s obviously a firm of high standards,” she proceeded to complete the dating questionnaire with her own answers.  She unilaterally replaced Harold’s beloved hearse with a sportscar, which she perceived as more befitting for her young son.  

B.    If you were using a specific assessment or screening tool, which would you use to elaborate on your assessment?  

            For baseline screening, I would use PHQ-9 for Harold’s depression and P4 for suicidality.  Prior to meeting Maude, Harold could self-report affirmatively to the following two PHQ-9 items, which support other depressive disorder:  Feeling down, depressed, or hopeless; and Thoughts that you would be better off dead, or thoughts of hurting yourself.  Harold expressed suicidal ideation and staged fake suicides not for his mother’s “benefit,” as he told his psychiatrist, but perhaps for his benefit to dramatically re-create “death” to gain his mother’s attention/affection (see F below).  While Harold had past suicide attempts and plan for suicide, preventive factors outweighed his probability of carrying out suicide. The fact that Harold kept himself alive through his staged suicides suggests that he was seeking more from his existence than his basic physiological and safety needs provided by his affluent mother, such as seeking to satisfy higher needs of belonging, esteem and self-actualization.  Harold appeared obsessed with death as an escape from his stultifying existence controlled by his emotionally cold mother. 

            Screening and assessing Harold’s mother for narcissistic personality disorder using her self-report is challenging because of the subject’s limited self-awareness and purposeful deception.  Instead, I would make a clinical judgment based on observations and DSM-5 criteria. 

C.    If substance use was part of the coping mechanism for the character/characters, how did it play a role with their overall symptoms? 

            Maude encouraged Harold to consume “after-dinner liquor” (alcohol = depressant) and smoke hookah (nicotine = both depressant and stimulant) in the context of sharing an activity, though straitlaced Harold said he didn’t drink and considered smoking a vice.  Maude seemed to market substance use as a coping mechanism to liberate Harold from being “too moral,” thus getting cheated out of “too much life” so he felt dead inside, or depressed.  Harold’s reluctance to partake in substance use likely alienated him from social conformists, especially during the early 1970s when hookah was popular and evidence of health dangers were not well-known at the time. 

D.    How would you engage with this individual/individuals in order to establish a strong therapeutic alliance?   

            To establish a strong therapeutic alliance with Harold, I would use Carl Rogers’ person-centered approach of showing unconditional positive regard for his well-being and empathic understanding through active listening and creating a safe space for Harold to express himself.  I would greet Harold with a warm smile, “Hi, I’m Awe Some.  How are you doing?”  I would observe and listen to Harold’s response.  Then, I would offer, “Would you like some water to drink?”  This introduction would set the tone for a safe, supportive environment by being courteous and attentive to Harold’s needs as a person.  Offering water demonstrates hospitality and encourages Harold to freely talk without undue concern about thirst.  Next, I would motion to a chair and offer, “Would you like a seat?”  Then, I would try to sit at a 45-degree angle from Harold for eye contact while placed less confrontational than directly in front of him.  This would be in contrast to Harold’s visits to his psychiatrist, who were not seen exactly eye-to-eye:  side-by-side so they had to awkwardly turn their heads to face each other, or Harold laying on the chaise staring at the ceiling and later sleeping.

            To meet Harold where he is, I would express my condolences to Harold over Maude’s passing, and adopt a cultural humility approach—assume nothing, be curious and interested in learning about Harold’s uniqueness in all its complexity.  As a guide, I would use the Cultural Formulation Interview (American Psychiatric Association, 2013, pp. 752-754).  Since individuals respond to loss in their own way, I would seek to understand Harold’s perspective and ask him how he is feeling about Maude’s death and his purpose in seeking therapy: “What brings you here today?” This open-ended question would allow Harold to respond with his own agenda, empowering him with autonomy and choice.  To respect his self-determination, I would communicate as a facilitator by suggestion, instead of direction, using motivational interviewing’s OARS:  Open-ended questions, Affirmation, Reflection, Summaries.  This approach is in contrast to Harold’s condescending psychiatrist (who lectured Harold, “I find you a very interesting case, but this reluctance on your part is detrimental to the psychoanalytic process”) and judgmental priest (who condemned Harold’s proposed marriage to Maude, ignoring their spiritual relationship and expressing disgust as he imagined their physical intercourse without goal of procreation—Harold’s “firm, young body co-mingling with” Maude’s “withered flesh, sagging breasts, and flabby buttocks”).

            Maude appears to be the only person who connected with Harold in any meaningful and reciprocal way, so seeing how Maude was able to draw out Harold, I would be authentic, use gentle humor and questioning as well as empathic listening to provide space for Harold to express himself including reminiscing on Maude’s influence and even making a list of Maude’s most memorable quotes for reference to feel better (see strengths and healthy coping mechanisms under G below).  I would encourage Harold, if ready, to continue exploring to find out what he wants, including sources of inspiration, joy, and purpose.  This approach is based on a strengths model focused on his existing resources. Finally, I would validate Harold’s strengths (see G below).

            I would be cautious in engaging with Harold’s mother because people with narcissistic personality disorder may lack insight so they may deny having any personality disorder. Mrs. Chasen appeared content with maintaining her status quo—a life of social events—rather than seeking to change herself, learn empathy through therapy, and develop a closer relationship with her son. 

E.    How did environmental factors play a role with the assessment? Describe how demographics, gender-sexuality, culture, housing, education, income, spirituality, biology and social support in general contributed to their psychosocial stressors and strengths?   

            Harold appeared to be an adult teen or twentysomething single heterosexual white male from a socio-economically privileged family background.  He attended boarding school and lived with his socialite mother in a mansion in the San Francisco Bay Area, which may have restricted his socialization to this social class and conservative lifestyle.  He appeared to be an only child, isolated from peers, and surrounded by, but mostly ignored by, adults in his home (mother and servants) and at funerals of strangers.  Mrs. Chasen, Uncle Victor and psychiatrist provided nominal social support to Harold.

            According to his mother, Harold was a “delicate child” prone to illness and his father had a “sense of the absurd” such as getting arrested for swimming in the nude.  Harold’s domineering mother decided after “an idle happy life of a child,” it was time for Harold to take on “adult responsibilities” and marry from a sense of noblesse oblige.

            Harold appeared clean-cut, ectomorphic and neatly dressed in blazer, dress pants and mostly oxford shirt with tie or turtleneck.  He was polite, introverted, quiet and sometimes morose.  His attitude was respectful and cooperative, following the rules and keeping appointments with dates—though with some rebellion, such as pulling pranks (self-immolation, chopping fake hand, and hara-kiri) to sabotage his mother’s plans for him to take on “adult responsibilities” like meeting prospective suitors through a computer dating service and enlisting him in the Army through Uncle Victor.  He also repurposed the sportscar his mother bought him into a hearse.  His rebellions were evidence of his intelligence, particularly his cleverness in staging realistic suicides and mechanical ability with redesigning the sportscar into a hearse.

            Harold presented wide-eyed, alert and oriented x3.  He was reticent, spoke in measured words, monotone, articulate manner.  His mood was mostly calm and euthymic, but uplifted in the presence of energetic and refreshing Maude who befriended him a week before she took her own life.  Even Harold’s pale skin tone acquired some coloring after meeting Maude.  His affect was mostly flat, detached.  He appeared to be going through the motions of what his repressive mother expected of him, a stifling situation that was probably “killing him” deep down inside.  He was unemployed, seemingly lacking purpose or meaning in his life.  When asked by his psychiatrist what he did for enjoyment, Harold replied he attended funerals; and he visited junkyards and observed demolitions. 

            Harold’s attendance at funerals might suggest yearning for spirituality, something deeper than the superficiality of his fleeting physically comfortable existence.  (Think Ecclesiastes 7:2: “It is better to go to the house of mourning, … for that is the end of all men; and the living will lay it to his heart.”)  At funerals, there is reflection on the deceased person that gives meaning to life and inspiration for the living on how they would like to be remembered.

            Harold’s mother appeared to be a WASPy, middle-aged widow, svelte and attractive, with perfectly coiffed hair and elegant dress.  She was self-absorbed, defensive, alert, oriented x3.  She was talkative; spoke fast, strong and clear.  Her mood and affect were detached; her thoughts appeared related to maintaining her social standing.  She expressed concern for her son by helping him find a wife and vocation in the Army, but otherwise she appeared self-satisfied.  

F.     Was there a history trauma/oppression that played a role in your overall assessment?  

            Though not explicitly addressed in the film, it’s possible that Harold’s depression—appearance of being socially withdrawn, emotionally restricted and numb and lack of interest in anything outside of death—could be related to a history of trauma from the loss of attachment to a supportive parent figure.  Mrs. Chasen’s apparent indifference might be a source of trauma/oppression as Harold related that “I haven’t lived, but I’ve died a few times”:  while in his boarding school’s chemistry lab, he accidentally caused an explosion leading police to assume he was killed so they informed his mother who reacted by collapsing into the arms of police; this was when Harold decided he “enjoyed being dead,” crying for his mother’s attention through staged suicides.  At times, Harold’s mother appeared to control Harold’s life: eating beets, finding a wife and vocation, buying a car, etc.  Harold did not mention his father, whose role in Harold’s life is unknown.                 

G.    What type of strengths and healthy coping mechanisms did you find in the character/characters?     

            Harold’s strengths are his personal qualities of being earnest, open-minded, empathic with a strong sense of morality; for example, he respectfully told Maude that driving off with strangers’ cars was “upsetting people, I don’t know if that’s right.”  Harold was open to forming a friendship with a more experienced older woman Maude, and learning her life’s lessons on how to live more fully in the process, so adaptation was his healthy coping mechanism.  In contrast to Harold’s escapism, vivacious Maude embraced life – attending funerals as a celebration of life – and showed him life is worth living and savoring with all senses (playing banjo for listening ears, painting for seeing eyes, odorific for smelling nose, etc.), nature (saving suffocating tree from city street and replanting in forest) and adrenaline-inducing experiences (though Harold questioned Maude’s stealing and reckless driving).  As an accomplice to Maude’s pranks, Harold began to consider her advice to take chances in life and get outside of himself to “look for new experiences” and “can’t let the world judge you too much.”  Maude did not appear tied to social conventions but appeared content to live a hedonistic life on her own idiosyncratic terms.  Reflecting on this might help Harold recognize that being true to oneself like Maude might be an alternative to seeking attention from his phony mother. 

          Just as Maude liberated the canaries from cages, we see Harold begin to break out of his existential crisis, becoming more expressive and open to new life experiences.  If Maude could survive the Holocaust (not mentioned, but suggested by her numbered tattoo in the scene when Harold holds her hand) and take back control of her own life, then Harold also could survive and take control of his own life, liberated from the strictures of his controlling mother. 

            In her irreverently charming manner, Maude used cognitive behavioral therapy to change Harold’s outlook and attitude, opening up possibilities that helped him cope with his depression.  When Maude asked him what kind of flower he would like to be and Harold pointed to a bed of daisies explaining “because they’re all alike,” Maude taught him to pay closer attention to observable differences, a metaphor for how each person is unique; and how much of the world’s sorrow come from people who are unique but allowed themselves to be treated otherwise.  Another example was when Harold faced despair over being enlisted in the U.S. Army, Harold partnered with Maude to make fun of the situation with Harold faking his passion for killing and feud with pacifist Maude, which ultimately persuaded Uncle Victor that Harold was not of sound mind for Army service. 

            Harold demonstrated strength in ignoring the superficiality of his mother, Uncle Victor, his psychiatrist and the priest who mainly noticed the age gap between Harold and Maude.  When Harold declared his love for dying Maude while riding in the ambulance, she encouraged him, “Go love some more!”  Harold was able to cope with death, which he did not deny or fear, and Maude helped him to accept death by viewing burials and birth as part of the “great circle of life.”  Maude hinted that she planned to end her life on her 80^th birthday on several occasions, including their first meeting (“80 years old, good time to move on, don’t you think?”) and advising not to get attached because “here today, gone tomorrow!”  

            Near the end of the film, we see the change in Harold, who had been nonchalantly faking suicides, but then reacted with real concern to Maude’s real suicide by rushing her to the hospital.  After Maude’s death, we see Harold speeding in his hearse that plunges off a cliff, which is another fake suicide as we see Harold on the cliff playing the banjo while skipping about like his mentor Maude who lived life joyfully.  Within just one week, Harold transformed to be more like Maude with a changed perspective that is life-affirming, a strength that will help him cope as he moves forward, appreciating one day at a time, living life to the fullest. Harold evolved from a depressed young man, perplexed about existence, into a stronger, more confident man with greater peace of mind.

            Harold’s mother had strength to survive widowhood and be a single parent to an only child who seemed to exasperate her with staged suicides.  She coped by referring her son to male caricatures like the banal psychiatrist and militant Uncle Victor.  She also used the strength of her socio-economic privilege to move ahead in the world, ignoring most obstacles, which seemed to suit her.  

Intergenerational relationships 

For my assignment, I avoided looking for DSM-5 diagnosis in Maude character.  After all, Maude’s appeal is her nonconformity/anti-Establishment stance, which is pathologized under DSM. Instead, I chose to focus on the value of the intergenerational relationship: Maude as wise mentor to younger, less experienced Harold, who has been oppressed by authoritarian figures like his mother, priest, psychiatrist, Uncle Victor (like Uncle Sam recruiter for US Army) trying to “cure” his eccentricity instead of embracing it like Maude.

Media reports on mutuality of intergenerational relationships:

·       “88-year-old graduates college alongside his 23-year-old granddaughter”: Rene Niera, terminally ill and in hospice care, achieved lifetime goal of earning economics degree, begun in 1950s and resumed while studying alongside his granddaughter at community college and then University of Texas (Today, Dec. 23, 2021). 

·       “Roommates and best friends: She’s 101, he’s 78”: Martin Jacobs was 55 when his mother introduced him to 80-year-old Jean Milgram in 1999, bonding over mutual interests (J Weekly, Dec. 21, 2021). 

·       “Teaching university students to be ‘age-conscious’ could help address our eldercare crisis”: The gold standard of intergenerational learning is through service learning, when both (younger) students and older people collaborate on an shared activity (The Conversation, Nov. 18, 2021). 

Interesting observation: 79-year-old Maude (played by then 74-year-old Ruth Gordon) had same brown hair coloring like much younger Harold (played by then 23-year-old Bud Cort, almost same age as Cat Stevens). 

2021: “Year of gray hair” 

“Before gray hair you should rise up, and you must show honor to an older man, and you must be in fear of your God.”—Leviticus 19:32  

If Leviticus had included honor to an older woman (and not just older man!), perhaps older women wouldn’t wait for COVID-19 pandemic lockdown to accelerate granny hair trend? (Or use Bible translations that refer to the elderly, old person, older people, the old, the aged, etc.)

Vogue (not quite an authority like the Bible) proclaimed 2021 “The Year of Gray Hair” with women embracing their natural changing hair color during COVID pandemic.  Several actresses wondered why can’t women be more like men who already “embrace” beautiful/exquisite gray hair?  

I feel better like this. Honestly, it’s exhausting to have to be something that you no longer are. I was finally like, “You know what? I’m not young. And I’m okay with that …I was looking at pictures of men, where they’re just their age, they’re normal, and we think they’re beautiful. I thought, okay, I may age and I want to be beautiful. So that’s where I got my “manspiration.”--Andie MacDowell (age 63), Interview (Oct. 19, 2021) 

There’s so much misogynist chatter in response to us that would never. Happen. About. A. Man…Does she have gray hair?’ I’m sitting with Andy Cohen, and he has a full head of gray hair, and he’s exquisite. Why is it okay for him?... It almost feels as if people don’t want us to be perfectly okay with where we are …whether we choose to age naturally and not look perfect, or whether you do something if that makes you feel better. I know what I look like. I have no choice. What am I going to do about it? Stop aging? Disappear?—Sarah Jessica Parker (age 56), Vogue (Dec. 2021) 

Today’s announcement of Betty White’s death at age 99 made me think I want to age like she did, more about her character than appearance.  

Don’t try to be young. Just open your mind. Stay interested in stuff. There are so many things I won’t live long enough to find out about, but I’m still curious about them.—Betty White (1922-2021), “Betty White, TV’s Golden Girl, dies at 99,” Associated Press (Dec. 31, 2021) 

https://www.youtube.com/watch?v=D9_wIu8ePxs&t=4s  

Judy Chicago, 82-year-old feminist artist with white/purple hair, has her own retrospective show at de Young Museum. She noted the female experience has been marginalized, so her work has been to intervene to “move art world where everybody’s voice matters.”

“What if women ruled the world?... Would old women be revered?”

--Judy Chicago, The Female Divine (2020) 

In The Female Divine (2020), Judy collaborated with all-women Chanakya School of Craft (Mumbai, India), which executed 11 velvet banners of hand embroidery and brocade, each asking rhetorical questions. More controversially, Judy’s smoke bomb show at Golden Gate Park was viewed as “radical hypocrisy.” 

Health is social

Oh my, omicron variant surge is here! Increasing COVID-19 cases and hospitalizations trending so another pause on home visits with clients, and return of universal indoor masking (though disappointed SF DPH adopted controversial CDC guidelines for shortening isolation time). According to CDC, 1 in every 100 older adults in USA has died of COVID-19, and more than 75% of COVID-19 deaths were people age 65+.  

Wonder when this world will embrace collective care (end vaccine apartheid!) rather than self-care? 

Here we go again, say Katherine J. Wu, Ed Yong and Sarah Zhang, in “Omicron Is Our Past Pandemic Mistakes on Fast-Forward” (The Atlantic, Dec. 23, 2021):

1.   We rush to dismiss it as “mild.”…but more transmissible virus can spread so aggressively that it ultimately causes more hospitalizations and deaths.

2.   We treat vaccines as all-or-nothing shields against infection.

3.   We still try to use testing as a one-stop solution…yet they need to be accessible, reliable and fast…COVID cases overwhelming USA’s frayed testing infrastructure.

4.   We pretend the virus won’t be everywhere soon.

5.   We fail to prioritize the most vulnerable groups…like older adults!

6.   We let health-care workers bear the pandemic’s brunt.

According to Ed Yong, public health needs to go back to its 19^th century progressive era roots of addressing societal weaknesses to prevent spread of epidemics (social solution for collective problem) v. relying on 20^th century germ theory that focuses on pathogens/vaccine solution.

“…public health began to treat people as if they lived in a social vacuum. Epidemiologists now searched for “risk factors,” such as inactivity and alcohol consumption, that made individuals more vulnerable to disease and designed health-promotion campaigns that exhorted people to change their behaviors, tying health to willpower in a way that persists today…

The biomedical view of health still dominates, as evidenced by the Biden administration’s focus on vaccines at the expense of masks, rapid tests, and other “nonpharmaceutical interventions.” Public health has often been represented by leaders with backgrounds primarily in clinical medicine, who have repeatedly cast the pandemic in individualist terms: “Your health is in your own hands,” said the CDC’s director, Rochelle Walensky, in May, after announcing that the vaccinated could abandon indoor masking…

If anything, the pandemic has proved what public health’s practitioners understood well in the late 19th and early 20th century: how important the social side of health is. People can’t isolate themselves if they work low-income jobs with no paid sick leave, or if they live in crowded housing or prisons. They can’t access vaccines if they have no nearby pharmacies, no public transportation, or no relationships with primary-care providers. They can’t benefit from effective new drugs if they have no insurance. In earlier incarnations, public health might have been in the thick of these problems, but in its current state, it lacks the resources, mandate, and sometimes even willingness to address them.”

—Ed Yong, “How Public Health Took Part in Its Own Downfall: The field’s future lies in reclaiming parts of its past that it willingly abandoned," The Atlantic (Oct. 23, 2021) 

Sounds awfully like medicalization of social work/clinical social work focused on professional self-care and pathologizing individual client instead of advocating to strengthen social safety net (universal basic income to lift people out of poverty, universal healthcare/long-term care system, paid sick leave, etc.). Need to put social back into social work!

https://www.youtube.com/watch?v=0QpjR6-Uuks

Yusuf Islam/Cat Stevens sounds and looks cool with gray hair at age 73! 

Now I've been cryin' lately
Thinkin' about the world as it is
Why must we go on hatin'?
Why can't we live in bliss?

'Cause out on the edge of darkness
There rides a peace train
Oh, peace train take this country
Come take me home again

              --Cat Stevens, “Peace Train” (1971) 

Rise

Herb Alpert’s Rise (1979 instrumental) has been playing like an earworm ever since I attended this month’s virtual screening of his documentary, thanks to AARP Movies for Grown-Ups. (While I had reservations about joining an organization that sells insurance and opposes single-payer healthcare, decided to invest in “risk-free” aka cancel anytime AARP membership for access to publications and events; no age requirement unless one wants to purchase age-restricted insurance products.)  

“Herb Alpert Is…” feel-good film this year, like his melancholy yet uplifting music! So mesmerizing, check out his Smile and Wonderful World.  With mandatory mask wearing in public due to COVID-19 pandemic, it will be some time before we can hear live wind instruments like trumpet playing so recordings are good for now.

Herb’s now 85 years old, nearly didn’t recognize him with his beard.  Walking past his elementary school in Los Angeles, Herb shared that a teacher couldn’t decide whether to give him an A or B grade for reading, so she brought in another teacher for him to read, and the teacher told him he was a “B reader, at best.”  From that point on, Herb said, he became an introvert.  Fortunately, his school also offered music appreciation, and Herb chose the trumpet, which “spoke” for him.  When neighbors complained about his trumpet playing, his mother encouraged him to play louder (not considerate!).  Despite mean teachers, industry v. inferiority resolved in favor of competence for Herb.

“Herb Alpert Is…” a beautiful life review, with Herb’s resolution of Erikson’s stages of psychosocial development to achieve virtues beyond competence: fidelity, love, care and wisdom.  Like jazz, this documentary is non-linear, improv-like, meandering with moments of Herb’s reflective self-awareness, vulnerability and earnest striving for authenticity: playing trumpet in the Army, where he perceived other trumpeters playing “better” so he determined to find his “own” voice, inspired to capture sounds of Tijuana Brass after attending a bullfight while on vacation (identity v. confusion, though critics today might accuse him of cultural appropriation?); ignoring Sonny Bono’s advice to “get out of the business” (industry v. inferiority revisited); being rich and famous, but miserable in Beverly Hills (he becomes silent in this exploration, so respect his privacy; as an introvert, I view famous=miserable), ending his marriage then getting remarried and moving to Malibu (intimacy v. isolation); getting “stuck” and unable to play until a teacher in NY helps him re-establish playing his trumpet, knowing how to compensate for not speaking much by partnering with spokesperson in business, trusting his intuition in signing some of my favorite singer-songwriters (Carole King, Cat Stevens, Peter Frampton, Sting/The Police, etc.) to A&M Records, which he co-founded so artists would be treated better (generativity v. stagnation).

As an older adult, Herb pays it forward by generously giving to music appreciation/arts education (notably Music Mends Minds intergenerational support group to address cognitive issues in older adults), waking up each purposeful day to “listen to your soul” with creative expression in daily (almost spiritual) practice playing his trumpet or piano, painting and sculpting for a remarkable legacy (integrity v. despair) and sharing his life process (wisdom).  Arts=liberation, much needed in K-12 and beyond!

For at least his first half century, clean-cut Herb appeared almost like Certified Young Person Paul Rudd, and documentary wasn’t too keen presenting chronology other than wife #1 came before wife #2; each wife appeared in videos of his #1 hits: This Guy’s in Love with You (1968, rare use of his vocals! wife #1 appeared quite hilarious in heavy mascara) and Rise (co-written by his nephew Randy, notable for spouting only F-bomb in film). Documentary is just under two hours, and I wanted more time with Herb, who is easy on ears and eyes, and maybe ask what did he think about Rise being used in rape scene in General Hospital soap opera? Herb Alpert is such an endearing blast to the past, as my boomer uncle played his vinyl records; and I liked listening to Rise on the radio (though Andy Gibb was my heartthrob in 1979 during a time when Video Killed the Radio Star). 

Herb defined himself primarily as an introvert and artist, which is so refreshing in these politically correct times that would expect him to identify as son of Eastern European Jewish immigrants.  As a MSW student required to take a diversity course, I was annoyed that an assignment required me to write about privilege and oppression based on identities of age, gender, sexual orientation, class, religion, mental and physical abilities, nationality, race/ethnicity,…but I could not select introversion that has defined my existence in a society that privileges extroversion?! 

As an introvert who values autonomy and solitude, I initially welcomed distancing and working remotely from home during COVID-19 pandemic...until my extroverted neighbors also were stuck at home blasting their music (not Herb Alpert) and interrupting my Zoom meetings.  With bars shutdown during stay home order, it’s like how Prohibition drove imbibing behaviors underground, as neighbors seemed to make their homes into bars with noisy guests carrying 6-packs and filling up recyclables bin with emptied cans/bottles of alcohol.

Pre-pandemic SF was crowded so welcomed news of recent exodus from SF, with whopping 96% year-on-year rise in housing inventory, thanks to remote work...but could this mean leaving behind mostly retired old people and people receiving government subsidies for basic needs (housing, SNAP, Medi-Cal, SSI, etc.) who contribute less tax? Society needs taxes to provide public services for the common good, and make government leaders accountable to resident taxpayers!

Anyway, my own school experience was like Pink Floyd’s Another Brick in the Wall (1979) with thought control and dark sarcasm in the classroom.  Elementary school was my introduction to losing autonomy and forced assimilation into the ways of an institution – something alien to my free-range childhood at home (and I was spared daycare/preschool).  I hated age-segregation (as my tabula rasa peers simply were not as interesting as my parents/grandparents), imposed afternoon naps in kindergarten, authoritarian school bell ringing, rote memorizing, series of holiday celebrations (which shaped my preference for truth-seeking like de-colonizing Thanksgiving), etc.  I also became an introvert and autodidact, preferring the sound of silence found in the library where I could quietly explore my curiosity.  

“You tell me it's the institution

Well, you know you better free your mind instead”

--John Lennon & Paul McCartney, Revolution (1968)

Those formative years shaped my resistance to this day, always seeking home and community-based services (HCBS) options over institutions that impose hierarchical and regimented structures (mass control), squelching self-determination, creativity and uniqueness. Growing up in a tight-knit family and faith community, members took care of each other, so I never gave thought to institutional care.  When I began my career in investment management and personal trust administration serving high net worth clients (“banking very few, very well”), money bought everything needed to support aging in place. 

(As an intense 20-something-year-old, I yearned for a more challenging career than simply throwing money to solve problems, so switched to institutional trust focused on qualified retirement plans to benefit rank-and-file employees.  My encore career as gerontologist has been the most challenging, largely due to confronting ageism at all levels—individual, institutional, structural/systemic—and its harmful impacts on quality of life.) 

No elementary school library would be complete without libertarian socialist Nathan J. Robinson’s charming antifascist children’s book, Don’t Let the Pigeon Question the Rules: A Parody for Tyrannical Youngsters (2014), which promotes the law of conscience and critical thinking of alternatives (why it’s preferable to “befriend” v. “get” a puppy) than unquestioning obedience in servitude to officious authoritarian/totalitarian mortals.  Likewise, consider a return to New Deal economist John Maynard Keynes, who fought authoritarianism with economic policies to live the good life 😊, because the value of human life does not depend on economic productivity.   

“The moral obligation that we all have is to help sustain the life around us, and we hope that others will sustain us too when we are “feeble” and in need.

…In the United States, work is the point of life, rather than life being the point of work. In many European countries, leisure is taken very seriously indeed, and the purpose of working is so that we may have more of it (leisure)… Life is beautiful in and of itself, and I do not need the old folks to produce scholarly papers in order to care about keeping them alive.”—UK-born Nathan J. Robinson, “Animals Are Pointless, And We Should Be Too,” Current Affairs (Jan/Feb 2020) 

Long-term care (LTC)

As an introvert, I tend to approach work like a cultural anthropologist doing non/participant-observation.  I have worked in institutional LTC settings like adult day health care (ADHC), assisted living facility (ALF) and nursing homes (non-profit, public), so I regard them as hierarchical workplaces.  These LTC facilities operated on the assumption that imposing “structure” (routines) on the lives of retired older adults was somehow beneficial—yet more likely to benefit budgets and staff work schedules.  Thus, I also associate LTC facilities with the gnawing disaffection of my oppressive K-12 years that I would not want to repeat (try watching Groundhog Day every day).  Group travel tours are similar (“you’re on tour, not vacation!”) but manageable because they’re short-term.

While ADHC and nursing homes operate under the medical model (qualifying for Medicaid/Medicare funding) and infection control training was part of orientation, ALF are non-medical (private pay) and could benefit from training.  Medical or not, congregate LTC facilities all operate under economies of scale, mass production with little personalization, though some ALF try to market as luxury lodgings with nickel and dime fees for services. 

In my experience, ALF residents seemed to cope with institutional life (and their medical ailments) through alcohol consumption, cannabis (actually knew two residents who got wealthy from cannabis production enterprises!), and considering California’s End of Life Option Act (EOLOA).  Self-education important because California EOLOA contains conscience clause so health care provider has no liability for “refusing to inform a patient regarding his or her rights…and not referring an individual to a physician who participates” (see Deciding with dignity: The terminally ill patient's right to information about California EOLOA and Dale-Jablonowski v. University of California Board of Regents case dismissed). 

None of these coping mechanisms were available to residents at nursing homes that received federal funds because cannabis (Schedule 1 substance) and medical aid in dying remain illegal under federal law; alcohol abuse was non-existent due to interventions from interdisciplinary team concerned over interactions with drugs or fall risk.

At ADHC under Community Based Adult Services before COVID-19 pandemic, participants were required to stay on-site for at least 4 hours each day for reimbursement ($76 from Medi-Cal Managed Care, $90 from Veterans Affairs).  But this attendance requirement was never enforced and even I turned a blind-eye because participants were mostly showing up for specific services: health care (physical therapy exercises, monitoring of vitals, medication management, etc.), social services (as-needed care coordination, case management, counseling, etc.), and hot lunch (depending on menu).  Participants who stayed 4 hours mostly had cognitive impairment and seemed indifferent to activities with blasting music (holiday celebrations, coloring, puzzles, etc. reminiscent of kindergarten), and they did not leave early because ADHC was respite for their family caregivers.  One silver lining of COVID-19 pandemic has been allowing ADHC “without walls,” accelerating flexibility of reimbursement for services delivered in private homes…closer to On Lok’s Program of All-Inclusive Care for the Elderly (PACE) model that combines HCBS.

On Lok changed its tagline from “Experience matters in senior care” to “Where seniors embrace life.”  Though a partner to SF Reframing Aging campaign, On Lok ignored Reframing Aging Style sheet to change the language: “Say older people or older adults” based on research that these terms are perceived as “more capable than seniors.”  More substantively, unveiling this rebranding seemed to reinforce Old Lives Matter, during this COVID-19 pandemic.  Particularly in residential LTC facilities, fixation on older adults at risk has “othered” them as passive, dependent and vulnerable in a medical model that decided they should not be allowed to take certain risks like embracing life via social visits with precautionary measures in place, while allowing psychosocial risk of extended isolation to jeopardize their well-being and “will to live.”  It has been unsettling to learn about former clients/residents "deaths of despair” while being protected from COVID-19 risk. 

Blame Industrial Revolution’s compulsory mass education for age grading, and using age to organize the tripartite division of life course into schooling, work and retirement. I also resisted this age-segregated institutionalized life course, in favor of age-integration by mixing schooling, employment and retirement with all ages—especially older adults with stories to share. Now COVID-19 pandemic has blurred these boundaries with homeschooling, remote work, and leisure at home… with less age-segregation, perhaps another silver lining in this pandemic?

According to Pew Research, multigenerational households are back, mostly out of necessity:  A majority of young adults in the U.S. live with their parents for the first time since the Great Depression. Intergenerational connections can help reduce ageism, and maybe return to family as informal support for LTC?

Nowhere to go, and all booked up

Attended Gerontological Society of America’s Age-Friendly University Special Interest Group Zoom meeting to get ideas as I develop curriculum to integrate aging content in MSW curriculum that engages students and promote more age-inclusiveness. Cool to see a couple of scholars (Rona Karasik, Nancy Kusmaul) who are included in my literature review on importance of student interaction with older adults, based on theories of social learning and intergroup contact to challenge ageism. To adapt to remote learning, contact includes exposure to older adults’ stories in films and books. 

10^th annual Legacy Film Festival on Aging scheduled this month did not take place, so I streamed several films listed in Professor Karasik’s article, Two Thumbs Up: Using Popular Films in Introductory Aging Courses; only a handful appeared deserving of thumbs up; and such a dearth of older women! My eyes really needed a break from the screen, so I turned to finding literature about older adults with emphasis on intergenerational relationships. When did I last read fiction as I have been so occupied listening to non-fiction experiences of clients/older adults and reading gerontology literature?

When asked “what do you want to be when you grow up?” I considered working in a library or publishing (but ultimately decided on careers that involved travel), so going to indulge here with books…

Reunited with Mills alum to join President Elizabeth Hillman (RBG doll on bookcase!), faculty (Elder in Residence Patricia St. Onge and Natalee Kehaulani Bauer, who are Natives) and students for discussion of Tommy Orange’s There There: A Novel (2018), a multigenerational story of Native Americans in Oakland. Native Peoples who relocated from reservations to urbanized ancestral lands found no there there—just a concrete place, like Gertrude Stein returning to her childhood home to find rural Oakland gone.  Older women (Opal cares for three great-nephews, Maxine is guardian) use the power of storytelling as antidotes to generational trauma (self-medicating to hide/forget with substance abuse and violence as legacy of colonial racism and genocide), offering hope/healing through multidimensional stories of resistance and renaissance (Alcatraz Island occupation) in contradiction to stereotypes…source of greater authenticity in searching for heritage and identity than googling “what does it mean to be a real Indian.” And the idea of home as spiritual community is powerful.

Mills College put up for sale works by dead white men: Shakespeare’s First Folio (1623) sold for nearly $10 million, and handwritten score by Mozart (1770s).  Persimmon Tree, a quarterly magazine by women over age 60 and published in association with Mills College, paid tribute to RBG in its latest issue. 

Litquake co-founder Jane Ganahl (also writes about solo aging) hosted discussion with Amy Tan (Boomer) and Kevin Kwan (Gen X), who both wrote books made into films about filial piety in Chinese families, The Joy Luck Club (1989, 1993) and Crazy Rich Asians (2013, 2018).

During her Zoom appearance, Amy moved her head away from screen several times, so got peek at her craftsman house in Sausalito, with views of SF Bay and Angel Island.  After contracting Lyme disease over 20 years ago, Amy and her hubby made plans to build an all-accessible two-bedroom house to age in place, with elevator, roll-in showers, walk-in bathtubs, wide sliding doors, etc. designed to be functional and beautiful using African mahogany and Asian aesthetic. 

Where the Past Begins: The Life and Work of Amy Tan documentary for PBS was in progress by filmmaker James Redford, who died at age 58 from liver cancer this month. 

Rachel Khong moderated Good Things in Small Packages: Writing Short Stories at Litquake.  She wrote short stories, magazine article about her Po-Po (grandmother) who had Alzheimer’s, and then her first novel, Goodbye, Vitamin (2017), about a millennial who returns home to help care for her father, a retired history professor diagnosed with Alzheimer’s. Probably should check out this novel before its film starring Constance Wu of Crazy Rich Asians.

Senior Planet’s Ryan Kawamoto hosted Ruth O. Saxton (ROS) Presents: Stories That Defy Expectations of Old Women.  Ryan introduced ROS as his classmate’s mother and Mills English Professor Emerita, recently retired after 46 years.  This spring she taught her final course with 15 Mills students and 30 Oakland Senior Center participants who were hungry for conversation beyond bingo and ballroom dancing activities.

Her latest, The Book of Old Ladies: Celebrating Women of a Certain Age in Fiction (2020), was a 20+ year project, begun at age 60 and interrupted by traumatic brain injury from a 2004 car accident.  To gather “examples of good aging,” ROS asked for recommendations, googled, hired students to look for stories, reviewed 100 stories before whittling to 31 stories organized in 5 chapters (Romancing the Past, Sex After Sixty, Altered Realities, It’s Never Too Late, and Defying Expectations).  After printing 800 copies, book sales going well so her book is being reprinted. (UK blogger Caroline Lodge maintains Older Women in Fiction Series.) 

ROS resisted “deathbed bookends,” or stories of a fictional older woman at her deathbed pining for unrequited romance of her youth, and challenged other stories of being a wife and mother as incompatible with career, citing her privileged position as white academic at an all-women’s college. (During this pandemic, women working in academia have struggled with demands of work and caregiving, with reduced productivity that could jeopardize their ability to get tenure—further exacerbating the gender gap where women represent 40% of tenured faculty…but perhaps this pattern is less so in an all-women’s college? ROS' daughter Kirsten T. Saxton, Mills '90, is also Mills Professor of English. Mills faculty can enroll children up to age 10 at Mills College Children's School on-campus.  In general, record numbers of women have dropped out of the workforce during pandemic, which has implications for their retirement security.) 

To combat ageism, ROS recommended: don’t let anyone tell you what you can’t do because you’re a certain age; have friends of all ages including your own cohort age; instead of young people limiting conversations with older people to nostalgia (“what was it like when you were little?”) talk about the present as well. 

SFSU Creative Writing Professor Carolina De Robertis (Mills MFA ’07) hosted super engaging chat with her former student, Jose Antonio Vargas (SFSU BA, Political Science, ’04),  about his memoir, Dear America: Notes of an Undocumented Citizen (2018).  Jose’s grandparents made it possible for him to immigrate from Philippines to California, in pursuit of the American Dream.  At age 12, Jose separated from his mother in the Philippines to live with his grandparents in California after his Lolo (grandfather in Tagalog v. Hawaiian word for idiot) paid $4,500 to a smuggler.  However, after Jose came out gay as a teenager, Catholic Lolo rejected him viewing homosexuality as a sin and complicating plan for Jose to marry an American woman to gain citizenship (before gay marriages became legal).  

As Jose turned to school as his “second home,” he benefited from mentors like his high school principal and superintendent who connected him to a network (“underground railroad”) that financed his SFSU education, living expenses, driving lessons and obtaining a driver’s license so he could pursue journalism. Jose explained that if freedom for undocumented persons like himself doesn’t come from government reform, then it must come from the people you trust: “Surround yourself with people who will say yes to you, who will open windows when all those doors are being closed.  Your survival and your strength comes from that.”

Jose decided to become a journalist because if he was not supposed to be in USA because he didn’t have the right kind of papers, he would write his existence into America by publishing his name (byline) on paper! But this risky endeavor concerned Lolo, who expected Jose to work in unassuming low-paying jobs that undocumented people often take.  Instead, Jose shared a Pulitzer Prize with other writers at The Washington Post.

At age 30, Jose came out as undocumented in his “Outlaw” (2011) essay published in The New York Times, followed by Documented: A Film by an Undocumented American (2013).  Jose faced age discrimination, being “too old” for adoption as a teenager and being “measly one year” over age 30 limit to qualify for DREAM (Development, Relief, and Education for Alien Minors) Act. 

“No human being is illegal.”—Elie Wiesel 

Though Jose thought “life did not start until 40,” he started writing his memoir at age 36 because he was tired of lying (not talking about his mom in Philippines, except with his grandparents), “passing” (replacing his native Tagalog with PBS manner of speech), and hiding (affecting his own mental health).  Jose used his handwriting on book cover, re-writing narrative of being undocumented=not citizen.  He also called out hypocrisy: undocumented farmworkers who are essential workers, but not essential humans?

http://sitn.hms.harvard.edu/flash/2020/racial-disparities-in-covid-19/

Public Service Announcement: Black, Indigenous, and People of Color (BIPOC) have been dying disproportionately from COVID-19, including many immigrants making up the majority of essential workers who more likely interface with others and sometimes without adequate protections (like employers who fail to provide PPE to workers who care for sick/frail people).  Support Essential Worker Bill of Rights! 

Jose also directed White People (2015), interviewing white millennials for MTV documentary...would be great to see follow-up on Old White People! Or undocumented older people who are also “lying, passing, hiding” with no place to age? So important to hear oral histories of diverse older people to counter white-washed history. (Happy 51st anniversary, Ethnic Studies!) When I worked in ALF, residents decided to “cancel” Thanksgiving after empathizing with painful history of genocide from watching Great Courses Plus series on Native Peoples of North America.  If more people can act likewise to cancel Thanksgiving gatherings, no worries about spreading coronavirus! 

Carolina also shared The Purpose of Power: How We Come Together When We Fall Apart (Oct. 2020), memoir and activist book by Alicia Schwartz Garza (SFSU MA Ethnic Studies ’17), co-founder of Black Lives Matter movement and organizer with National Domestic Workers Alliance.   

Institute of Noetic Sciences (IONS) hosted Shifting Ageism: How Consciousness Affects Our Experience of Aging. 

According to the history of ageism, older adults as knowledge keepers (storytellers) for the community began to lose their status when the printing press was introduced in 1440.  Yet, living older adults retain value with their oral histories (memories)—particularly if invited to dialogue.  Being genuinely curious enough to listen to older people about their lives and ideas have led to ideas about my own future, what really matters in life, adapting to and surviving challenges, etc.—how to become a more understanding person?

“Local” privilege

Attended Weaving Voices: Looking to Our Past for New Political Visions, which asked, “What kind of leadership do we need to take us out of COVID-19?” This Zoom meeting featured recorded oral histories of political leaders “to revisit the era of economic change from plantations to tourism, and political change with the return of AJAs and rise of the Democratic Party in the 1950s…sparking huge transformation.”  Following statehood, Hawaii Lt. Governors were Native Hawaiian-Chinese: James Kealoha (Republican 1959-1962), William Shaw Richardson (Democrat 1962-1966).

Included in the otherwise all-male lineup of politicians was Helene Hale (1918-2013), who represented Big Island of Hawaii, retiring at age 88 after suffering a stroke. 

Because my parents are aging in place in Hawaii, I pay attention to COVID-related news that might impact them.  I decided to postpone visiting them, especially frightful to learn how COVID passengers allowed to fly and/or die on flight. Hawaii government’s COVID response has been so frighteningly chaotic during its latest surge that U.S. Surgeon General Jerome Adams was dispatched to provide federal support for COVID-19 testing and contact tracing (after purge of incompetent state health and public safety officials placed on paid leave), and then Hawaii police arrested Adams for taking pictures in a public park! 

Anyway, this political visions program based on oral histories of long-dead politicians could have benefited from voices of living kupuna, preferably Native Hawaiian (like University of Hawaii Professor Emeritus Haunani-Kay Trask), “talk story” based on memories of this transition when Hawaii went from Republican (haole, Chinese) to Democrat (Japanese, Filipino) rule, political party identification stratified along race/ethnicity and social class; Hawaii stuck in Democratic Party groupthink (giving meaning to Ezra Klein’s claim that opposite of polarization is suppression, not consensus).  Sounds like Hawaii needs another transformation to get out of COVID!

“If the Republican Party gave us sugar, the Democrats gave us Waikiki.  If the Republican Party gave us racism, the Democrats gave us another form of racism.”—Haunani-Kay Trask, Centennial of the Overthrow (Jan. 17, 1993)

Two non-kupuna, non-Native, non-local panelists (one female, one male so at least there was some gender diversity!) alluded to current leadership challenges like lack of accountability in Democratic Party (“incumbency protection racket”), lack of transparency in Governor’s suspension of Sunshine laws that closed off public meetings/records during pandemic, less economic diversity from working class representatives like earlier politicians who grew up in plantations to be “more responsive to social welfare issues”, etc.

“Today, modern Hawai’i, like its colonial parent the United States, is a settler society. Our Native people and territories have been overrun by non-Natives, including Asians. Calling themselves “local,” the children of Asian settlers greatly outnumber us.  They claim Hawai’i as their own, denying indigenous history, their long collaboration in our continued dispossession, and the benefits therefrom.”—Haunani-Kay Trask, Settlers of Color and ‘Immigrant” Hegemony: “Locals” in Hawai’i (2000) 

What I found noteworthy in program (but not highlighted by panelists, even after my question about plantation "no make waves" culture stifling progress was read during Q&A) was recording of State Senator John Ushijima (1959-1982) discuss how attending college in the mainland gave “locals” a different perspective from the prevailing “plantation mentality” and motivated them to seek change for “mobility.” Note current Hawaii Governor: “local” who never lived outside Hawaii for any substantial time to gain a different perspective, so he maintains status quo, like denying Medicaid to Micronesians and approving retroactive pay raises for unionized state workers despite growing budget deficit during pandemic.

“When I think back on all the crap I learned in high school

It’s a wonder I can think at all…

Everything looks worse in black and white…”

--Paul Simon, Kodachrome (1973)  

These are mere observations as I have no family history connected to plantations in Hawaii, which gave rise to “local” culture like mixed plate and Pidgin English, synthesizing disparate ethnic contributions to reinforce polarization of insider (“locals”) v. outsider (haoles, recent immigrants) and marginalization of Native Hawaiians seeking sovereignty.  Interracial people seem to identify with group based on appearance, like Barack Obama identifies as Black, though he was raised by haole mother and maternal grandparents. 

Generational trauma seems to keep Hawaii as provincial small-town: “Locals” size up people based on “eh, where you wen’ grad (high school),” fluency in Pidgin/Hawaiian Creole English (resistance against Standard English representing haole oppression), ethnicity, and tanned complexion.  Forget racial paradise myth: “locals” (as in Asian settlers, rather than Native) take care of their own tribe in plantation tradition of “divide and control,” rampant patronage, ethnic groups pitted against another (ethnicity-based pay differential, segregated housing), resulting in shabby treatment to Native Hawaiians and most recent immigrants – painfully apparent with Micronesians during this syndemic. Leave it to “locals”/their allies to praise their replication of racial capitalism/plantation village built on a floodplain for formerly homeless families that provide source of cheap labor (exploitation) to benefit nearby laundry business owned by former First Lady.  Is this indicative of leadership that will take “us” out of COVID-19? 

COVID-19 corner

Woo-hoo! Last week, SF became the 1^st Bay Area county and 1^st major city in California to rise to least-restrictive/minimal yellow tier for reopening during this COVID-19 pandemic.  Wonder how much being stuck at home to avoid smoke from wildfires helped?!

According to SF Department of Public Health (DPH) COVID-19 data tracker based on 681,211 test results reported to date: 12,399 positive cases and 148 deaths (64% male; 58% age 81+, 16% age 71-80, 14% age 61-70, or 88% of deaths age 60+; 38% Asian, 25% Latinx, 22% White, 6% Black; 1% homeless).  Total COVID-19 deaths: over 229K in U.S., over 1 million worldwide. 

SF has averaged 5,000 tests per day (exceeding goal of 1,800) and positive coronavirus test rate of 0.89.  Of the 20 most populous U.S. cities, SF has the lowest positivity rate and the lowest COVID-19 death rate. 

Yesterday, SF decided to pause further reopening next week due to uptick in SF’s key health indicators over last two weeks, COVID-19 cases (rise from 3 daily cases per 100,000 residents to 4 per 100,000, or 25% rise, signaling orange=moderate alert) and hospitalizations (rise from 23 to 37 patients, signaling red=high alert).  Data-driven SF DPH Director Grant Colfax reported other rises in COVID-19 cases, statewide and nationwide: 38% in California, 41% in U.S.; and since we don’t yet grasp the magnitude and potential duration of these increases, pause will help mitigate virus, adding “I wouldn’t be me unless I reminded you” to keep wearing masks, physically distance, wash your hands, avoid large groups, etc.    

According to CDC, self-reported engagement in COVID-19 mitigation behaviors (mask wearing, handwashing, physical distancing, crowd and restaurant avoidance, and cancellation of social activities) was highest among age 60+ (Boomers +) and lowest among age 18–29 group during April to June.  Whereas mask wearing increased over time, other reported mitigation behaviors decreased or remained unchanged. 

SF allows "shared spaces" for outdoor dining on sidewalks, so diners are unmasked while drinking booze and talking loudly—spewing respiratory droplets and aerosols further on passersby, practically forcing me to road facing traffic.  Unacceptable during this pandemic, so I called 311 to complain that outdoor dining should be in parklets, and my complaint was referred to SF DPH. Back in April, I emailed suggestion to SF COVID-19 Economic Recovery Task Force to adopt plexiglass partitions on dining tables as done in Hong Kong, which never shutdown dining during pandemic. 

While COVID-19 cases have increased, COVID-19 deaths appear flat mostly due to treatments learned six months after pandemic (that certainly benefited President Trump’s recovery from COVID-19).  In KZYX Coronavirus Update, Dr. Drew Colfax explained that physicians now know aggressive treatments for low oxygen level like use of ventilators may have been counterproductive; keep lungs dry instead of giving fluids that fill up lungs of COVID patients; rotate entire body regularly in prone position to increase oxygen; dexamethasone and remdesivir. This is reassuring news, unless one ends up with long-haul COVID, while we wait for vaccine/herd immunity. 

While adapting to New Normal, I miss hearing Dr. Drew Colfax’s earlier rants about how this COVID-19 pandemic was entirely preventable if there had been stronger national leadership.  This continues to be the case so worth repeating and ranting! It is unconscionable for government to fund corporate welfare, like $21 billion “no strings attached” COVID-19 relief to nursing homes (of which 70% are for-profit), without expectation to invest in resident care and safety of direct care staff.  Need to demand better because accountability and transparency is critical to take us out of COVID, restore public trust, and ensure survival of storytellers!