ESSAYS BY MICHEL ODENT, M.D.
7. Gaps in Primal Health Research
INTRODUCTION
To date, the “Primal Health Research data bank” contains hundreds of references and abstracts. At first sight “Primal Health Research” is in progress. In fact, when considering the number of papers that are published every day in the scientific and medical literature, it appears that most epidemiologists are strangers to this framework. They do not have the “Primal Health Research Reflex”. When studying behaviors or states of health in adolescence or adulthood, they rarely try to know what happened to the mother when she was pregnant, how she gave birth or how the baby was fed. When studying events that can occur during the primal period, for example an obstetrical intervention, they only consider the short-term consequences. This is remarkable in the age of computers, a time when it is easier than ever to explore correlations between different phases of our life. If American, Western European, Japanese, and Australian researchers were as curious and productive as the Swedish in this field, our data bank would explode!
Our data bank can be considered a tool that facilitates a new awareness. The concept of primal health research stimulates curiosity. It inspires many questions. I am familiar with these questions. They are either expressed orally, for example at the end of a lecture, or by e-mail. I must confess that one of my most common answers is: “This is an interesting question. Unfortunately, there is still a gap in primal health research regarding this issue”.
FREQUENTLY ASKED QUESTIONS
One of the most frequently asked questions is about the long term consequences of being born by caesarean section, particularly elective caesarean. What do the caesarean born people have in common when adults? Such questions are of paramount importance at the age of elective caesarean on demand, particularly in certain Latin American cities where the rates of C-sections are above 50%. There are many anecdotes confirming that when doctors discuss the topical issue of C-section on demand - that is without any medical indication - they only think of the possible short-term consequences. Those who support such attitudes underline that today a planned C-section is a very safe operation and they focus on the risks for the perineum, which are particular to vaginal birth. Those who do not support such attitudes walk into the trap of being stuck in sterile discussions by sharing the same short-term perspectives. They never think that the way we are born may have long term consequences. They never try to enlarge the topic by stressing that, where human beings are concerned, we must also think in term of civilisation. What is the future of a civilisation born by caesarean?
In spite of the paramount importance of this frequently asked question, there is a lack of available hard data. Our data bank only mentions two relevant studies (key word "caesarean delivery"). Both studies are by the same Finnish team about the risk of having asthma in relation to caesarean birth. The most recent one, dated April 2001, is about 1953 subjects born in 1966. At the age of 31 years, those born by caesarean had a risk of being diagnosed as having asthma multiplied by 3.23. This study did not separate emergency operations and planned operations, but one can assume that in 1966 most caesareans were performed during labour. The same key word leads to another study, which is not very useful in the context of the year 2001. It is about 97 subjects born by caesarean in 1952-54 after a long labour. These subjects had an average low IQ later on in life. Fifty years ago, most caesarean sections were performed in extreme situations as a last resource, so that such findings cannot inform our understanding of the effects of operations performed in a modern context.
Another frequently asked question is about the possible long-term effects of being born after induction of labour. In fact there are similarities with the issue of elective caesarean, so far as both induction and elective caesarean imply that the fetus and the maternal body do not play any role in the initiation of labour. In certain cities the rates of induced labour are in the region of 20%. Among the rare studies in our data bank found via the key word "labour induction" are those by Niko Tinbergen and Rioko Hattori about autism. A paper by E.A. Friedman and colleagues is more specifically about induced labour, but the follow-up of the children was short (between 23 and 56 months). It is noticeable that the results of this study suggest that the use of oxytocin in order to initiate labour is associated with more developmental and neurological abnormalities than the use of prostaglandins. The common sense and the intuition of many women indicate the need for further research addressing the issue of long-term consequences. Such studies would be feasible in places, such as several British cities, where the rates of induction were high in the mid 1970s.
Dyslexia is topical. However the key word "dyslexia" leads to only one entry. It is a Norwegian study looking at school performances at age 8 to 9 in relation to routine ultrasonography in utero. Six-hundred-and-three children had specific tests for dyslexia. According to this study routine exposure to ultra sound during fetal life does not influence the risk of being dyslexic. Many other possible risk factors for dyslexia might be taken into consideration. It is noticeable that neither "attention deficit disorder" nor "hyperactivity" are included in our list of key words, whereas lay people are highly curious about these conditions, which are apparently more and more common. If lay people could participate in the establishment of research protocols, attention deficit disorders would jump at the top of the list of current preoccupations.
I received a message by a French jurist who is constantly close to prisoners and who is teaching criminology in a university. When exploring our data bank she suddenly realised that there are probably risk factors for becoming a violent criminal in the primal period. There are such a small number of studies from a primal health research perspective that she had never heard of them. It is significant that, at a time when many forms of violence are increasing, nobody wants to explore a possible link with the evolution of obstetrics these past 30 years.
The most intriguing gaps are about early multiple vaccinations. It is impossible to find a prospective randomised controlled study about the long-term effects on health of different combinations of vaccinations during the primal period.
The case of centenarians illustrates the widespread, even cultural, lack of interest for the root of health. Every day journalists interview healthy centenarians and try to unveil their secrets. The questions (and answers) never deviate from certain aspects of lifestyle such as nutrition and patterns of diet, sleeping patterns, physical activity, level of education, socio-economic status, consumption of alcohol and cigarettes, the purity of the air where people live, the ability to manage stress, the number of children they had and at what age (most centenarians are women) etc. Now and then there are allusions to genetic factors via details about the longevity of the parents and other members of the family. The questions are not basically different when the approach is more scientific. The best example of scientific study is the New England Centenarian Study, which began in 1994 in the Boston area. It is clear that nobody wants to know about the primal period, that is, the time when our basic adaptive systems are in a phase of development and have not yet reached their maturity1. Common sense indicates that any event occurring during this phase of development should have long-term consequences. Where does this lack of interest for the primal period come from? What a waste of money and what a waste of time and expertise in health research!
THE SCIENTIFICATION OF FORGIVENESS
To date the capacity to forgive is the only aspect of the capacity to love that scientists are able measure. This would make easy studies from a primal Health Research perspective. Yet, instead of wondering how the capacity to forgive develops, researchers prefer to address usual questions about the value of therapeutic intervention in order to help people to forgive, or to look at forgiveness as a psychotherapeutic goal, or to look at forgiveness in relation to other personality trait.
I use this opportunity to offer to subscribers one of the additional chapters included in the forthcoming second edition of my book "The Scientification of Love"8. Chapter 16 of the new edition is called "The Scientification of Forgiveness". The other additions provide data that are familiar to the subscribers of our newsletter, because they were included in the essays about "antenatal scare", “pre-eclampsia" and "From fetal vulnerability to adult adaptability." The capacity to forgive is in itself a subject that deserves to be studied in depth. We all have the experience of situations when our capacity to forgive has been put to the test and, on the other hand, of situations when we wanted to be forgiven. However (after emphasizing the weaknesses of the studies about centenarians) I include this chapter first as a way to analyze again a common scenario in modern research: researchers have at their disposal a precious "material", but they waste it because they do not yet have the "Primal Health Research Reflex". How can we facilitate the development of this “reflex”? Why have most academic researchers not yet realized that human life starts at conception?
CHAPTER 16
The capacity to forgive may be presented as a facet of the capacity to love. Forgiveness has been held as an important virtue by most societies throughout history and around the world. This facet of the capacity to love is of paramount importance at a time when Humanity must invent new strategies for survival. The necessary dialogue between Humanity and Mother Earth remains impossible as long as old conflicts between ethnic groups and nations are not overcome. Developing the capacity to forgive is the prerequisite to enter a new phase in the history of our species.
A New Phenomenon
The scientific study of forgiveness developed during the very last years of the twentieth century. There was a landmark in October 1997. At that time the John Templeton Foundation invited more than forty scholars to participate in a conference in Holland, Michigan, in order to initiate forgiveness research and to establish a grant programme2.
This landmark was made possible thanks to preliminary steps dated 1992. Two teams then independently placed at the disposal of researchers psychometric instruments for measuring forgiveness. The Enright Forgiveness Inventory (EFI) is a 60-item scale. It has a scoring range of 60-360, with higher scores indicating greater forgiveness. The tests developed by Mauger are unique in that they attempt to measure forgiveness as a trait rather than as a response to an isolated interpersonal offence. They have a special interest in the framework of our study of the scientification of love because they distinguish the capacity to forgive others and the capacity to forgive oneself: “FOO scale” measures “forgiveness of others” while “FOS scale” measures “forgiveness of self.”3 These measures are included as subscales of a larger personality inventory, the “Behavioral Assessment System” (BAS). Until now researchers have mostly used the Enright inventory.
The published studies of the capacity to forgive can be classified in three groups according to their objectives. Some tried to test the efficacy of a therapeutic intervention. Others studied forgiveness as a psychotherapeutic goal. Others examined the relation of forgiveness to other personality traits such as anxiety, depression, religiosity and social desirability. Each group can be illustrated by an example of a published study.
Examples
A study by C. Coyle and R. Enright belongs to the first group. The objective was to test the efficacy of a therapy within a sample of men who identified themselves as being hurt by their female partner’s decision to have an abortion.4 The average time span between the abortion and study participation was six years. One group was randomly assigned to participate without any delay in a personalised specific psychotherapy that included a series of twelve 90-minute sessions. The other group was on a waiting list during twelve weeks. Before and after the therapy, the participants completed a series of tests, including the Enright Forgiveness Inventory; the other tests were the state anger scale, the state anxiety scale, a perinatal grief scale and a self-forgiveness scale. According to this study an intervention designed to promote forgiveness has therapeutic benefits in excess of what could be expected through the passage of time and repeated testing alone.
A study by J. Hebl and R. Enright belongs to the second group. Women participating in this study were over 65 (mean age 74 and a half). They had reported a specific, painful forgiveness issue and were not currently grieving over a major loss (5). Some of them were randomly assigned to group therapies focusing on the concept of forgiveness. Others participated in free discussions on non-specific subjects. In both cases the sessions were an hour long and repeated during 8 weeks. Before and after the series, all participants completed tests measuring anxiety, depression and self esteem. At the end of the series they were tested with a simplified 30-item version of the Enright Forgiveness Inventory. They also completed a16-item test called “willingness-to-forgive scale”. Both the experimental and the control groups appear to have been therapeutic for participants. However, the experimental group appears to have met its goal of increasing forgiveness in its participants. Forgiveness, in turn, was associated with greater mental health within the entire sample.
A study by M. J. Subkoviak and colleagues belongs to the third group. The objective was to study the relation of forgiveness to anxiety, depression, religiosity and social desirability.6 Three-hundred-ninety-four college students (204 females and 190 males) formed half the sample. Their mean age was 22. The other half consisted of their same-gender parents (mean age 50). Participants were asked to recall the most recent experience of being hurt deeply and unfairly by someone. They then completed the Enright Forgiveness Inventory. They also completed other tests assessing their anxiety, their sociability and their religious practice. Forgiveness was associated with lower anxiety scores, a relationship that was especially strong for students experiencing deep hurt. No significant correlations with depression were found. The student group appeared to find forgiveness more difficult than the parent group. Although there was no relationship between forgiveness and the seven-item religiosity measure, persons who were affiliated with a religion showed slightly higher levels of forgiveness than those who were not affiliated.
THE FUTURE: HOW THE CAPACITY TO PARDON DEVELOPS
It is noticeable that the capacity to forgive is the only facet of the capacity to love that researchers have tried to measure. It is also noticeable that until now researchers have not raised the fundamental question: “How does the capacity to pardon develop?” The Primal Health Research perspective offers new avenues for research. It should be possible today to explore the capacity to love in relation to what the birth was like, to what happened to the mother when she was pregnant, to the mode of infant feeding, etc. Both Primal Health Research and Scientification of Love are at an early phase of development.
REFERENCES
1. Odent, M., (1986/2002). Primal health: Understanding the critical period between conception and the first birthday (2nd Rev. ed.) East Sussex: Clairview Books.
2. Worthington, E. (Ed.) (1998). Dimensions of forgiveness. Templeton Foundation Press.
3. Mauger, P. A., Perry, J. E., Freeman, T., et al. (1992). The measurement of forgiveness: Preliminary research. Journal of Psychology and Christianity, 11, 170-80.
4. Coyle, C. T., & Enright, R. D. (1997). Forgiveness intervention with post-abortion men. Journal of Consulting and Clinical Psychology, 65, 1042-1045.
5. Hebl, J. H., & Enright, R. D. (1993). Forgiveness as a psychotherapeutic goal with elderly females. Psychotherapy, 30, 658-667.
6. Subkoviak, M. J., Enright, R. D., Wu, C., et al. (1995). Measuring interpersonal forgiveness in late adolescence and middle adulthood. Journal of Adolescence, 18, 641-655.
7. Reichlin, S. (1993). Neuroendocrine-immune interaction. New England Journal Medicine, 329(17), 1246-1253.
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