Author: Daniel Harper

Anxiety screening

The U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation statement on Tuesday, suggesting that everyone under age 65 might benefit from screening for anxiety disorder.

Before you jump to conclusions, you need to know a few things.

First, this is still a draft statement. The USPSTF has released this draft for public comment. After the public comment period ends on October 17, the USPSTF will prepare the final statement.

Second, despite its impressive title, the USPSTF is not a government agency. It is “an independent, volunteer panel of national experts in disease prevention and evidence-based medicine.”

Third, this report appears to rely on data published before the COVID-19 pandemic. In other words, this is not a response to the widely-reported rise in anxiety disorder during and following the pandemic.

But even after reading this draft statement carefully, and even if we don’t jump to conclusions about the effects of the pandemic, I think this is still important. As the draft recommendation points out: “According to U.S. data collected from 2001 to 2002, the lifetime prevalence of anxiety disorders in adults was 26.4% for men and 40.4% for women.” In other words, anxiety disorders were widespread before the present alleged post-pandemic rise in anxiety disorders. This is a serious public health issue.

Anxiety is also obviously a serious issue for women. With over 40% of women developing anxiety disorder, this is indeed a serious public health issue. And in fact the USPSTF reports that “the Women’s Preventive Services Initiative [already] recommends that screening for anxiety should include all female patients age 13 years or older not currently diagnosed with an anxiety disorder, including pregnant and postpartum women.”

The USPSTF draft recommendation also points out how anxiety correlates with age and stage of life: “The natural history of anxiety disorders typically begins in childhood and early adulthood, and symptoms appear to decline with age. Some community-based epidemiology studies indicate that rates of anxiety disorders are lowest in adults ages 65 to 79 years, but these data are outdated.” So this becomes an important concern for parents, educators, and anyone in the helping professions who works with young people.

Also of interest: the USPSTF notes that screening tools to help medical professionals identify persons who may have anxiety disorder are widely available. Mind you, these are screening tools, not diagnostic tools. But as screening tools, they can cue medical professionals to schedule a follow-up diagnostic assessment. I found one of these screening tools online on the University of Washington website, and it takes only a few minutes to complete. So you can see how this screening tool could be added to routine examinations by primary care physicians.

Now that we’re not going to jump to conclusions, we can go on to speculation.

If there really has been a rise in anxiety disorder during and following the pandemic — and I suspect there has — then it may prove to be even more important to screen for anxiety.

And there are implications for those of us who are ministers. We’re not mental health professionals, but tend to be on the front lines of mental health care because of the people we see during formal and informal pastoral care and counseling. We often suggest that people seek out mental health care. This report suggests that we may want to become more aware of anxiety disorders.

Why you should seek out a nonprofit hospice provider

It turns out private equity firms are buying up hospice providers. And it turns out the for-profit hospices do not, in general, provide as much care for dying patients as the nonprofit hospices, according to Kaiser Heath News:

“Patients in nonprofits had more nursing, social worker, and therapy visits. For-profit hospices, the report found, had longer lengths of stay by patients, discharged more patients before death, and had profit margins nearly seven times higher. Other studies have found that for-profit hospices have higher rates of complaints and deficiencies, provide fewer community benefits, and have higher rates of emergency room and other hospital use.”

Why are private equity firms buying up hospices? Obviously, they want to make money, and they are not particularly concerned with the details of providing hospice care:

“With the U.S. population rapidly aging, hospice has become a boom industry. Medicare — … which pays for the vast majority of end-of-life care — spent $22.4 billion on hospice in 2020…. That’s up from $12.9 billion just a decade earlier. … But with limited oversight and generous payment, the industry is at high risk for exploitation. Agencies are paid a daily rate for each patient — this year, about $200 — which encourages for-profit hospices to limit spending to boost their bottom lines. For-profit hospices tend to hire fewer employees than nonprofits and expect them to see more patients.”

Read the article, and I think you’ll be convinced that if you ever need a hospice provider, you’ll really, really want to find a nonprofit.

The mood in England

JB, a friend from high school, has been living in London for a number of years. His essay titled “The Mood in London” helps explain to us Yanks what it’s like to be in England right now. More interesting to me was his account of what it was like to stand in line to view the Queen lying in state. Like this ritual that he witnessed:

“Rather than a walk-past (when visiting the Crown Jewels you’re actually standing on a moving conveyor belt), each person was allowed a moment or so to contemplate or bow, as many people did. It was just as I was paying my respects that I was asked to move on, to make way for the changing of the guard. This was an extraordinary spectacle with a new team of sentinels marching to the catafalque (the platform that held the coffin), and positioning themselves directly behind the waxworks. Then, by clockwork, the petrified figures displayed their sentience, seeming to lurch alive and step forward, as their replacements took their positions and powered down to a fugue state. The rescued team then marched, like wind-up soldiers, to a stone staircase, which they ascended in military precision and before disappearing through a door. This ceremony was repeated every 20 minutes, and whatever its origins, it was a remarkable sight.”

Global chalice lightings

The International Council of Unitarians and Universalists (ICUU) is now defunct, another victim of COVID. According to Inga Brandes, ICUU President in 2021, “With the Covid Pandemic, the climate Emergency, and underlying funding issues, ICUU is facing major problems of sustainability and impact.” And so we now have the International U/U Collaboration.

This is sad, but not entirely surprising. As I understand it, ICUU funding has been precarious for some time. All best wishes to the new group.

However, in the transition, the old ICUU website disappeared, along with some 212 “global chalice lightings.” The global chalice lightings were words for lighting the chalice, submitted by Unitarian / Universalist communities from around the world, and often translated into multiple languages. These were a tremendously useful resource. Not only did they give insight into the internal diversity of global Unitarian and Universalist communities, not only were many of them useful in worship services, but they also were one of the only linguistically diverse Unitarian Universalist resources we had.

Yes, we have UU hymns and readings in Spanish. But here in the United States, there are Unitarian Universalists who are fluent in many other languages, and/or whose first language is other than English. For example, in my past two UU congregations, I shared global chalice lightings in Portuguese, French, and German with native speakers of those languages. I’ve known one or two African American Unitarian Universalists who felt some connection to global chalice lightings from Nigeria, and the occasional Filipino American Unitarian Universalist pleased to see global chalice lightings from the Philippines.

I hope someone has saved all those global chalice lightings, and makes them available again. The new website of the International U/U Collaboration has less than a dozen of them. I can’t find them on the UUA website. I did manage to get all the global chalice lightings from 2003 through 2014 from the Wayback Machine. But after 2014, it’s much more difficult to pull the global chalice lightings from the Wayback Machine.

The ICUU global chalice lightings are undoubtedly covered under international copyright. So I’m not going to post any of them here on my website (though I’m willing to share them with individuals if you email me directly). And if you happen to have a collection of ICUU global chalice lightings from 2015 on, and you’re willing to share, please leave a note in the comments below!

Thinking about Abigail Eliot

Abigail Eliot was a member of the Unitarian Universalist church I grew up in. I have only vague memories of her, but somehow knew she was someone important. I didn’t realize just how important she was until I read No Silent Witness: The Eliot Parsonage Women and Their Unitarian World by Cynthia Grant Tucker.

It turns out that Abigail Eliot was a pioneer of early education in the United States, and one of the founders of the National Association for the Education of Young Children (NAEYC). Eliot first trained at Margaret McMillan’s famous nursery school in England. McMillan developed the nursery school for children who lived in English slums; her school was designed to educate the whole child, mind and body, including nurturing health through outdoor education. Eliot returned to the United States and founded the Ruggles Street Nursery School in Boston.

While Eliot was not the first person to bring the nursery school concept to a city in the United States, she was one of the most influential pioneers of American nursery schools. She founded her school in 1922, and four years later turned her school into a training center for other nursery school teachers. Eliot’s training center for educators continues in the Eliot-Pearson Children’s School, a lab school that’s part of the Eliot-Pearson Department of Child Study and Human Development at Tufts University.

In addition to the material on Abigail Eliot in No Silent Witness, here are links to more information about her life and work:

I think Abigail Eliot has become a spiritual exemplar for me. She dedicated her life to child-centered education, and in so doing used her significant intellectual talents for the betterment of humankind. I wish I had better memories of her, but all I really remember is seeing her walk down the driveway to her house near the church. My friend Alison, who is my age and grew up in the same Unitarian Universalist church I did, is lucky enough to retain vivid memories of Abby Eliot. Perhaps not surprisingly, Alison went on to a lifelong career as a kindergarten teacher, and now Alison’s daughter is a schoolteacher in East Boston.

Those older Unitarian Universalists, people like Abigail Eliot, inspired many of us younger Unitarian Universalists to devote our careers to making the world a better place. Many of those older Unitarian Universalists worked in fields that are mostly ignored by the public. (Sadly, Abigail Eliot’s contributions to humankind receive far less recognition than those of her famous poet cousin, T. S. Eliot.) Yet what I learn from those older Unitarian Universalists is that public recognition is less important than doing good work in the world. That’s one of the reasons why we should continue to hold them up as spiritual exemplars.

Living out of your car

We left our rental in San Mateo, California, on June 20. From then until September 1, we didn’t have a permanent address. We were living out of our car from June 20 to July 17. Then we had a short-term and very inexpensive rental ($500 a month, plus work barter) on the south coast of Massachusetts. As of September 1, we finally have a permanent address on Boston’s South Shore. Even now, most of our belongings are still in storage, and we’ve been living with whatever we managed to pack into the car.

We’ve had a pretty comfortable summer, all things considered. But our experience has made me think about what I’ve heard from some of the homeless people I’ve known. Now most of the homeless people I’ve known have not been street people. There are quite a few different kinds of homelessness. There’s couch-surfing, where you do short-term stays with friends and family, often rotating amongst several people so no one gets sick of you. There’s living in an RV or converted van, which can entail parking at night with friends or family, or parking at night in state or county campgrounds, or parking on the streets; the latter option is where you’re the most vulnerable. There’s car dwelling, which less comfortable than RV or van dwelling, since you have to sleep in a seat not a bed. There’s living in long-term homeless shelters, where you’re guaranteed a bed in one place for at least a month at a time. There’s living night-to-night in homeless shelters, where you have to line up every day to get a spot in the shelter. Then there’s living on the street, where you’re sleeping outdoors pretty much all the time.

In the popular imagination, “homelessness” means the last option: living on the street. But really homelessness is a state of being where you don’t have a permanent address. It’s a state of being where you have a lot less control over your life, and a lot less predictability. Considered this way, homelessness is similar to being a refugee.

As I said, we’ve had a pretty comfortable existence. We have adequate income, and we knew we’d find a permanent place to live sooner or later. We have enough stability, and enough money, that we could be somewhat picky about our rental options.

As comfortable as we are, not having a permanent address caused a certain amount of stress. It can be difficult buying things online, and these days you almost have to buy some things online, but with no permanent address where are you going to have them shipped? (We solved that problem by renting a mailbox at a UPS Store, which is not inexpensive.) There’s stress associated with the ambiguity of not really having a permanent legal address. There’s stress because your clothes always look a little rumpled; even I, a slovenly dresser, have found this to be annoying. There’s psychic stress: sometimes you don’t quite know where you’re going to be next week, and that’s uncomfortable. There’s more psychic stress: you feel a definite lack of control.

Again, we’ve been quite comfortable in the last two and a half months, but all these little stressors have added up. I’m more tired than usual, and less efficient. Even though I have a solid job, and we have solid financial resources, living out of a car is tiring.

This tallies with what I’ve heard from the homeless people I’ve known. They’ve talked about how the uncertainty can wear you down, can make you less efficient. Then if you’re looking for work on top of that, or working a low-wage job (and low wage jobs are far more stressful than knowledge-worker jobs), it’s all going to add up. You’re going to be tired and stressed out.

This is something to think about when we’re thinking about how to help people who are unhoused. If you tell unhoused people to get a job first, or to kick their addiction first, I’m not sure that’s actually a pragmatic, practical approach. Based on my brief experience living out of a car, I tend to believe that it makes more sense to put people in housing first, then when they have some stability in their lives they’ll be able to address the other problems.

Clerical stoles

In two earlier posts (one and two), I wrote about preaching gowns. Personally I’m not a fan of preaching gowns, but I understand why they can be of use. Now I’d like to think out loud about clerical stoles.

Stoles are those long pieces of cloth that clergy drape around their necks. The stole comes from the Christian tradition. I don’t remember Unitarian Universalist clergy using stoles until the 1980s. My recollection is that Eugene Pickett, when he was president of the Unitarian Universalist Association, insisted that clergy should wear stoles. By the 1990s, clerical stoles were pervasive in Unitarian Universalism. And by 2003, the year I participated in the Service of the Living Tradition as a newly ordained minister, I think I was the only minister who didn’t wear a stole.

Some people understand the stole to be a symbol of ordination. But choirs that wear robes often also wear stoles, and we generally expect most of our choristers to be non-ordained persons. So I’m not convinced that the stole is a symbol of ordination, and only to be worn by ordained clergy.

Also, stoles are reminiscent of other special religious clothing in other traditions. A stole is somewhat similar in appearance to the Japanese Buddhist wagesa, though the wagesa has very specific symbolic meanings (as I understand it) which obviously differ from any symbolism a stole might have. A stole is perhaps slightly reminiscent of the Jewish tallit or prayer shawl, insofar as it’s something to drape over your shoulders when engaging in religious observances.

It seems to me that there are other cultures that drape long pieces of cloth around your neck. Think of Hindu men who wear a dupatta over a sherwani for their wedding. I feel like there are other examples, though I can’t think of any right now. So even though there’s a strong connection between the stole and Christianity, it you take the cross off a stole maybe it’s not a Christian stole any more. When Unitarian Universalist minister Hank Peirce wears his Boston Bruins stole, there isn’t much connection between the stole and Christianity.

I don’t like wearing a preaching gown, but I feel reasonably comfortable wearing a stole. I think of it as a uniform. Like when I worked at the lumber yard, and I had to wear a shirt with a “Concord Lumber Corp.” patch over the shirt pocket, and my first name embroidered on the other side of my chest. (And yes, I’ve thought of having a stole made with a patch that says “First Parish Unitarian Universalist” on one side, and my name embroidered on the other side, but rejected the idea for obvious reasons.)

I wish I didn’t have to wear any special clothes to be a minister. As a Universalist, I think all humans are of equal worth, and wearing special clergy clothing sets my teeth on edge. But I realize that people want to see their clergy wearing some kind of uniform. For me, a stole represents a reasonable compromise between egalitarianism and the need for a uniform. So on Sunday, when I participate in the Town of Cohasset 9/11 observance, I’ll be in uniform, wearing a stole.

(Getting a stole for Sunday proved to be a challenge. I have a stole that my younger sister gave me when I was ordained, but it’s still in a moving container somewhere. I just found out about the Cohasset 9/11 observance, and had to get a stole on short notice. But finding a stole without any Christian symbolism on it, that could be overnighted to me, was a challenge. I finally found Threads by Nomad, a small company that’s trying to provide clothing that doesn’t do “damage to people or the planet.” They had clergy stoles on sale and they were able to overnight one to me. Sadly, it looks like they’re selling off their stole inventory, so maybe it hasn’t been a good business opportunity for them. Their website tells me that the stole I bought was “made from a fabric called mud cloth from Mali. Mud cloth is dyed using fermented mud — a traditional dying technique in many parts of the world but notably in West Africa. Our mud cloth is not mass produced and therefore every piece is different in design.” Since I’ve been influenced by African philosophy, this seemed like a serendipitous find. Plus the stole was made by an “artisan [who was] fairly compensated.”)

What I did on my summer vacation

Back in July, Carol and I drove to the Cumberland County Fairgrounds in Maine.

We sang Sacred Harp, in a pulling shed, with forty other Sacred Harp singers. There were horses trotting around the race track next to the pulling shed.

Click on the image above to view the video on Youtube

The pandemic shut down in person singing for a long time. It felt really good to sing with other people in person.

I was glad to see that someone posted videos of us singing, so I could be reminded of one of the highlights of my summer vacation.

Night sky

If I walk out the front door of the house we’re staying in, sometime after it’s fully dark, and look up, I can see the Milky Way. For the past thirteen years I’ve been living in the San Francisco Bay Area, which has so much light pollution that you’re lucky if you can see a few stars at night. In that whole thirteen years I probably saw the Milky Way fewer than ten times. So even though we’ve been living in Westport for a month and a half, I’m still amazed when I look up and see all those stars.

When I was a child, I remember seeing the Milky Way all the time. But gradually, light pollution grew worse and worse there. By 2003 when my father sold that house that we’d grown up in, you could see far fewer stars. And for most of my adult life, I’ve lived in cities or congested suburbs where I couldn’t see the stars.

It feels good to look up and see the Milky Way. I guess it helps orient me to where we are in the universe. By next week, we’ll be living in Cohasset. We’ll be in the midst of the massive light pollution of Greater Boston. I’m glad that I’ll no longer be spending three and a half hours a day driving to and from work. But I’m going to miss the beauty of the night sky.

The Ted memorial rest area

For the past month, we’ve been living in Westport, Mass., and I’ve been commuting to my new job in Cohasset, Mass. It’s at least an hour and a half drive, more if there’s traffic. By the time I come home, I’m often tired of driving. Fortunately, there’s a rest area almost exactly halfway between the church in Cohasset and our temporary place in Westport. I often find myself pulling into that rest area to stretch my legs and clear my head.

It’s not much of a rest area. The parking lot is too small for the amount of truck traffic, with big rigs everywhere. By contrast, the lot for cars is usually mostly empty. Inside the building, there’s a Burger King and a Dunkin Donuts. But they seem to sell most of their food at their drive-through windows, because there’s hardly ever anyone sitting in the dining area. In spite of all the tractor trailer rigs, the whole place feels oddly deserted.

I stopped there on my way home today. It was lunch time, and the dining area was as deserted as usual. A memory forced its way to the surface of my consciousness. Back in 2008, I was working in New Bedford, and once a month I’d drive up to Newton for Sacred Harp singing. Ted, whom I sang with in another choir in New Bedford, started getting into Sacred Harp singing, too. So we’d drive up together to sing Sacred Harp. But I’d often have missed dinner in order to sing, so on the way home we’d stop at this exact same rest area to grab a sandwich. We’d spend the long drives talking, and we’d sit in that deserted rest area — even back then, it was always deserted — and talk some more while we ate. Mostly we talked about music. I still remember how he said he used to sing with five different ensembles when he lived in San Francisco, one for each night of the week.

When I moved to California, I lost touch with Ted. I’m not a good correspondent, and neither was he. A few years ago, I learned from one of his siblings that he had died.

Ted and I both sang bass. He was a pleasure to sing next to, not just because he was a good musician and a good singer. Some choral singers are on an ego trip, wanting to show off how good they are. That kind of singer is not fun to sit next to. Ted was the other kind of singer, the singer who’s there for the music, who subsumes their ego in the music. Marge Piercy talked about something similar in her poem “To Be of Use”: “I want to be with people who submerge / in the task … / who are not parlor generals and field deserters / but move in a common rhythm / when the food must come in or the fire be put out.” Piercy was talking about work, not music, but you see the same kind of thing in music. As it happens, I did actually do physical work with Ted on several occasions, and he worked the way he sang: submerged in the task, rather than a parlor general. That’s the kind of person I like to spend time with.

When I was in the rest area today, I got to thinking about Ted. I guess for me, that’s now the Ted memorial rest area. Not a bad thing to think about while I’m stretching my legs and getting a sandwich.