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The Medical Implications of Nuclear War, Institute of Medicine. ~ 1986 by the National Academy of Sciences. National Academy Press, Washington, D.C. Children's and Adolescents' Perceptions of the Threat of Nuclear War: Implications of Recent Studies WILLIAM R. BEARDSLEE, M.D. Harvard Medical School, Boston, Massachusetts OVERVIEW Substantive findings on the attitudes of children and adolescents toward the threat of nuclear war are reviewed. The evidence indicates that many youngsters are bewildered and perplexed by the threat of nuclear war. Some are frankly troubled or frightened. They often find out about it alone, through the media, or from their peers, without help or guidance from their usual circle of caring adults. Helplessness and a sense of pow- erlessness, as well as a profound sense of fear about the future, may accompany the realization. The methodological issues in the findings to date are discussed, and the implications of these findings are explored. INTRODUCTION Increasing concern has been expressed by educators, parents, mental health professionals, and children themselves about what effects the threat of nuclear war may have on children. The considerable attention in the media, the formation of such groups as Educators for Social Responsi- bility, the development of curricula and programs in response to the need to educate high school and junior high school students about the nuclear threat, and the development of children's groups opposed to nuclear war reflect this concern. Surprisingly, most work on this question appeared either in the early 1960si-6 or after 1980. The first recent studies started in the late 1970s 413

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414 IMAGES AND RISKS OF NUCLEAR WAR and indicated that there was concern about the threat of nuclear war in a substantial number of those high-school-aged youngsters that were sur- veyed. John Mack and I conducted the first of these studies.7 Our initial study was an in-depth questionnaire study, partially qualitative, partially quantitative, that eventually involved 1,100 youngsters from venous parts of the country. It was undertaken to see whether this was an issue for youngsters at all. The results strongly indicated that it was. Most striking were the qualitative responses of youngsters in the Boston area to open-ended questions administered in 1978. A few of their verbatim responses indicate the depth of the youngsters' concern. For example, in response to the question "What does the word nuclear bring to mind?" some students gave the following answers: "Big grey clouds, pipes and smokestacks, red waiving lights, dead wildlife and humans, unnecessary death and violence." "Danger, death, sadness, corruption, explosion, cancer, children, waste, bombs, pollution, terrible devaluation of human life . . . "Stars, planets, space, darkness . . ." "All that comes to mind is the world's final demise, final kind of holocaust. " In response to the question "When did you first become aware of the nuclear threat?" a student said, "I believe I was in junior high when I first became aware. Of course I found it terrifying that every human being in my whole world could be destroyed by one bomb that our nation had first discovered. The bomb that every advanced civilization has sought to obtain. To destroy our race, to destroy people, culture, life on the earth, is essentially the outcome of the A bomb." In response to the question "What effects has the threat of nuclear war had on you?" two students answered as follows: "I think that unless we do something about nuclear weapons, the world and the human race may not have much time left." "In a way it has. It has shown me how stupid some adults can be. If they know it could easily kill them I have no idea why they support it. Once in a while it makes me start to think that the end of my life, my time in life, may not be as far off as I would like it to be, or want." Altogether, three samples totaling 1,143 students from public and pri- vate high schools in three cities across the country were given the ques- tionnaire. The three samples were collected in 1978, 1979, and 1980. Most of those studied were adolescents and all were in school when

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CHILDREN'S AND ADOLESCENTS' PERCEPTIONS OF NUCLEAR WAR 415 questioned. The initial 1978 questionnaire elicited open-ended essay re- sponses, while the subsequent two questionnaires had a quantitative for- mat. The sampling was not systematic in any standard sociological sense, but an effort was made to obtain urban and suburban schools and to have all children in the classroom fill out a questionnaire when any one child in that classroom was asked to. Quantitative analysis revealed that there was no uniformity of political opinion and that very few young people had taken an active position. However, the responses reflected a profound dis-ease and uncertainty about the future and a considerable amount of general pessimism. The majority of youngsters were concerned about at least some aspect of the threat of nuclear war, and a number were afraid. The respondents were relatively alone with their fears and not certain what to do. Their primary informants were the media and schools, not their parents. Other nonsys- tematic opinion surveys yielded similar findings.8 The results of the study described above must be viewed as preliminary and hypothesis generating for several reasons. There was no systematic sampling. The questionnaire focused solely on the nuclear issue rather than being a more general inquiry about youngsters' attitudes about various matters, so that the respondents knew specifically what the investigators were interested in, and this may have affected their responses. There was no attempt, other than in a qualitative way, to rank order or address the relative degree of their concern about the nuclear issue to other concerns. Since 197S, a large number of studies have been conducted. These address some of the methodological shortcomings of nonsystematic sur- veys, while they also leave some areas unexplored. In a broad sense, four different kinds of studies exist which address not only the question of how many youngsters voice some concern about the issues but also how important this concern is in their lives. The four kinds of studies are as follows: (1) systematic survey research, using standard techniques con- ducted in the United States; (2) in-depth questionnaires which attempt to address the relative weight of concerns about this issue, as opposed to other concerns; (3) international studies; (4) in-depth qualitative studies. Representative studies from each area will be reviewed in order to highlight the findings, although this review is not intended to be a complete or exhaustive one of all studies. SYSTEMATIC SAMPLING The best evidence about the importance of this issue from a study using rigorous sampling techniques has been conducted by Jerald Bachman and

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416 IMAGES AND RISKS OF NUCLEAR WAR associates. He has presented findings about the threat of nuclear war as it relates to youths as a part of a study of adolescent attitudes toward the military and the draft.9 Recently Bachman presented findings from surveys of students in seven consecutive graduating high school classes 1976-1982. Each yearly sur- vey was conducted during the spring. In order to sample representatively, a three-stage probability sampling approach was employed, and through this approximately 130 public and private high schools from 48 states were selected from a much larger pool of schools. Between 77 and 85 percent of all the students in the classes selected were studied, and the total sample size (by year) ranged from 16,662 to 18,924. A series of questions were asked in the area of monitoring the future. One question asked was: "Of all the problems facing the nation today, how often do you worry about each of the following?" One possible choice was chance of nuclear war. There has been a steady rise in the percentage of those who worried about the nuclear threat. In 1976, 19.9 percent of male seniors never worried about it, while in 1982, only 4.6 percent of the males never worried. Similarly, in 1976, 7.2 percent of the male seniors said they worried about it often, while in 1982, 31.2 percent did. Female high school seniors showed a similar dramatic change over the seven-year period. Another statement in the series was: "Nuclear or biological an- nihilation will probably be the fate of all mankind within my lifetime." There was a steadily increasing trend for both boys (from 23.1 to 35.3 percent over the seven-year interval) and girls (from 20.2 to 36.0 percent) to agree or mostly agree with this statement. It is important to understand these findings in the context of the Michigan Survey data* as a whole. in While there is an increase in those who agree with the statement about nuclear or biological annihilation, nonetheless, in 1982, for example, slightly more than 15 percent of all high school seniors indicated that they disagreed with this statement. Similarly, the majority of seniors surveyed in 1982 responded that they agreed or mostly agreed with the statement: "The human race has come through tough times before and will do so again." The larger study provides clear evidence on another point of interest. Are youngsters from less affluent homes or of minority group status con- cerned about the threat of nuclear war? In the 1982 data, seniors in high school not planning to attend college had consistently more pessimistic responses than those planning to attend college. As those who attend college, in part, come from families with higher social status, this argues *I am indebted to David Beardslee, Oakland University, Rochester, Mich., for a review of and insight into the Michigan Survey data.

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CHILDREN'S AND ADOLESCENTS' PERCEPTIONS OF NUCLEaR WAR 417 against the notion that this is a class-bound phenomenon. In terms of race in this survey, 46 percent of the black seniors agreed or mostly agreed with the statement, "nuclear or biological annihilation will probably be the fate of all mankind within my lifetime," as compared with only 34 percent of the white seniors. Fundamentally, these survey research data show few class differences in response to worrying about a variety of problems and no evidence that less affluent youngsters are less concerned. Standard opinion survey research involving adolescent populations has also confirmed that this is a significant issue for a large number of young- sters. As one example from a number of surveys, Gallup1l reported on a representative national cross section of 514 teenagers, age 13-18, con- ducted from April to June in 1984. About half (51 percent) indicated that it is somewhat likely that a nuclear war will be started during their life- times, and 15 percent of the group reported that it is very likely to happen during their- lifetimes. Of this group of teenagers, 49 percent said that the possibility of nuclear war has had some influence on how they plan for the future, and 25 percent described this influence as serious, in terms of thinking or planning about the future. As another example, Offer and colleagues interviewed 356 high school juniors from the Chicago area during 1983-1984 as part of an ongoing comprehensive study of adolescent development. Respondents were both white and black and covered the range of the middle class: lower, middle, and upper. When asked a general question about problems facing the world, about one-fifth of the students voiced concern about nuclear issues (war and energy). Those who worried about nuclear issues did not have a specific profile-that is, they were not different from the rest of the sample with respect to gender, race, or socioeconomic status; nor did this group differ on measures of idealism, coping abilities, drug abuse, or delinquency. 12 RELATIVE WEIGHT OF NUCLEAR WAR VERSUS OTHER ISSUES John Goldenring and Ronald Doctor13 l4 have studied a large group of adolescents in southern California with a questionnaire which they de- veloped to address the question of the relative weight of concern about the threat of nuclear war. Questions about the threat of nuclear war were embedded among questions about other representative worries of adoles- cents. Youngsters were asked to rank each of 20 main possible worries in terms of four degrees of worry: not worried at all, worried a little, moderately worried, very worried. In a separate, later section of the ques- tionnaire, there were direct inquiries about the threat of nuclear war and the possibility of survival. This questionnaire was administered to 913

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418 IMAGES AND RISKS OF NUCLEAR WAR students in May 1983 in the San Jose and Los Angeles areas (ages 11- 19) representing grades 7 to 12 with a wide range of ethnic backgrounds. The sample was largely middle and lower income families. The highest rated worry was about parents' death, and the second highest rated worry was getting bad grades. The third overall worry was the possibility of nuclear war, with 58 percent responding that they were worried or very worried about the possibility. When the students were to indicate their top 5 worries out of a list of 20, concern about parental death remained highest, and concern about nuclear war moved up to second. Of those surveyed, 33 percent considered nuclear war often, and more than half thought a nuclear war between the United States and the USSR would occur in their lifetimes. Despite the high levels of concern, 51 percent admitted they never spoke to their parents about nuclear war, and 39.4 percent had talked with them about it only a few times. The chief sources of information were television, school, and newspapers, with parents much less frequently being a fourth source. Surprisingly, 42 per- cent reported that they felt they had not been given sufficient information about nuclear issues in school. Youths who were most worried in the sample showed significantly better scores on a series of statements that measured self-esteem and adjustment. This group had also talked more often with their parents about nuclear war, and despite their increased levels of concern, they were more hopeful that nuclear war could be prevented than were their less overtly worried peers. These findings were replicated with a sample of 250 southern California suburban adolescents. Although not based on a national sample, Goldenring and Doctor's find- ings substantiate the earlier nonsystematic observations. INTERNATIONAL STUDIES The last few years have witnessed a remarkable growth in the study of young people's attitudes in a variety of countries. This review is not exhaustive but will indicate the breadth of studies conducted. Finland In a methodologically carefully conducted study in Finland, Solantaus and colleagues,~5 ~6 using standard sampling techniques, surveyed 6,851 youngsters, age 12-18 years. The study was carried out as part of a larger study of health habits, and the youngsters were thus not questioned only on war and peace. A questionnaire was administered by mail, and the response rate was 81 percent. A total of 108 items formed the questionnaire and concerned living conditions, family, school, health, health habits, exercise, and psychosomatic symptoms. Respondents were asked for the

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CHILDREN'S AD ADOLESCENTS' PERCEPTIONS OF NUCLEI Wow 419 three main hopes that they had for their own lives and their futures and also the three main fears that they had, and then the experience of war was investigated by eight structured questions. Of all fears, fear of war was by far the most frequent, with 81 percent listing war as one of their three main fears. In terms of the corresponding question about hopes, hopes concerning work and employment were ranked first, and hopes for peace were expressed by about a third of the respon- dents. Solantaus remarked that it is paradoxical that while as many as four out of five respondents expressed fear of war, hope for peace was expressed by only a third. She offered the speculation that peace may be an empty concept for young people, meaning mostly an absence of war. Solantaus noted that girls' reactions to the threat of war seemed stronger than boys' and speculated that boys are socialized to expect to see not the whole picture but only the positive aspects of combat. In terms of social class, the threat of war was in the minds of respondents of all social classes. Young people who were confident about their own contribution to the prevention of war had more anxiety about war than those who did not see the possibility of change. A small group reported that it had an effect on their daily functioning. Canada Sommers and associates ~7 completed a questionnaire survey in Toronto, Canada, in 1984. They used a questionnaire with 103 items in which the nuclear questions were embedded in other questions about other areas of concern in order to minimize bias. It was administered to over a thousand students in six public schools in metropolitan Toronto. A wide range of ages and sexes were represented, as well as a wide range of social classes. The students were equally distributed over grades 9 to 13. The authors caution that this sample is urban in nature, has somewhat of a represen- tation of high social class and educational level in two sections of the sample, and has a large representation of immigrants. Students were asked to state their three strongest hopes and their three greatest worries. These were then coded into 11 categories following the scheme developed by Solantausi4 is in Finland. Students were then asked to rate nine possible hopes and nine possible worries in terms of how important they were, and then they were asked about three future-oriented domains: unem- ployment, job and career plans, and threat of nuclear war. In terms of the open-ended questions, the highest percentage of students mentioned work and employment first (41 percent) and war and peace second (29 percent). A total of 51 percent mentioned war and peace as one of their three major worries, the highest rating of any category. On multichoice questioning, 63 percent of the students indicated that nuclear

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420 IMAGES AND RISKS OF NUCLEAR WAR war was a very important issue or worry for them, as it was ranked second out of the nine possible worries, the first being parents' death. Ten percent of the sample reported thoughts about nuclear war daily. Thirty percent reported having some thoughts at least twice a week. Sim- ilarly, 8 percent reported fear or anxiety about nuclear war almost every day and 24 percent reported these feelings once or twice a week or every day. The majority of students reported that they had no influence in preventing a nuclear attack, which contrasted with their attitudes on job and career plans. They further perceived that their parents had little in- fluence on preventing a nuclear war. In comparing unemployment, job plans, and threat of nuclear war, in terms of being discussed at home, nuclear war was talked about least. Television and newspapers were the primary source of information on this topic for those surveyed. Faced with the threat of nuclear war, 24 percent admit some or a lot of desire to live only for today and forget about the future. Surprisingly, 16 percent had sought counseling or advice for worries about nuclear war at school, and 9 percent sought counseling or advice for worries about nuclear war outside of school. The authors compared the groups who reported daily fear with the group identified as "all others." The groups did not differ in terms of sex, Canadian birth, or whether their parents had been active. They did differ in being younger and having lower social economic status. Interestingly, students who were more anxious and fearful about nuclear war also thought more about their personal future. In addition, they felt that they were more likely to have some personal influence on the political process. The fears thus were not associated with feelings of helplessness, but with a greater sense of personal efficacy. Surprisingly, the authors conclude, "The data further suggests that those who say they are not fearful and anxious at all, may also be at high risk for difficulties. It is in this group that the students express the most helplessness and show the least interest in planning for their own future."6 New Zealand Gray and Valentines have reported about the knowledge and attitudes of New Zealand's secondary school children toward nuclear war based on a survey of 876 fifth, sixth, and seventh form students. This ques- tionnaire dealt solely with the nuclear issue. A number of questions dealt with factual information, and others dealt with attitudes about it. Alto- gether, 90 percent of the sample had seen, heard, or read something about nuclear weapons, largely from television and other forms of the media. Half (50 percent) of the sample thought that the situation at present would deteriorate through more armaments or world war in the future; very few

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CHILDREN'S AD ADOLESCENTS' PERCEPTIONS OF NUCLEI Wit 421 were hopeful about disarmament as a realistic possibility. Students said that they did not feel they knew enough about nuclear weapons. Sweden In Sweden, Holmborg and Bergstrom have studied a sample of 917 adolescents, age 13 to 15, with the help of the Swedish Institute for Opinion. They used an instrument that was adapted from Goldenring and Doctor's~3 ~4 questionnaire, as the questions about nuclear war were embedded in general concerns about teens' worries. The number one worry, both in mean score and percentile ranking, was nuclear war, with 42 percent listing it as their greatest worry. This was higher than the score in the study of American youth by Goldenring and Doctor. i3 ~4 The death of a parent was listed second. A total of 24 percent reported thinking about a nuclear war between once a week and daily, and 26 percent thought a nuclear war would definitely or probably occur during their lifetime. Only 17 percent of the sample felt that adults were very worried, and 46 percent thought that adults were very little concerned. Of the teenagers surveyed, 67 percent stated that they received insufficient information or none at all, and 63 percent of those sampled seldom or never talked to anyone about their worries. Two-thirds of the sample thought that the USSR, the United States, and Europe would not survive a nuclear war. There was some optimism in that three-fourths of the teenagers showed faith that various actions could do something to prevent a nuclear war. International Survey Research The findings of these more detailed studies are supplemented by standard survey research findings. For example, in 1981 the Institute of Peace Research at the University of Groningen in The Netherlands20 surveyed 13- and 14-year-olds in Groningen. The majority of the children believed a nuclear war would occur and would destroy their city, and almost half thought that they would not survive. In West Germany, public opinion polls show that approximately 50 percent of the young people between the ages of 18 and 24 expect the world to be destroyed by nuclear war. Similarly, in Britain, in 1983, a representative sample of teenagers, age 15-18, was surveyed, and 52 percent thought it was either extremely or quite likely that nuclear war would occur within their lifetimes.22 USSR-United States Eric Chivian and associates23 have, in collaboration with Russian phy- sicians, studied Soviet youth with a questionnaire very similar to that used

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422 IMAGES AND RISKS OF NUCLEAR WAR by Goldenring and Doctorl3 l4 and compared the findings to their findings in the United States. Studies were conducted in 1983 in two pioneer camps for youngsters. One was a camp for children whose parents worked at a domestic airport, and the other was a camp for children who had been selected as outstanding in one or another respect, such as academic per- formance, athletics, or citizenship. The youngsters were interviewed, sin- gly or in groups, and were also surveyed with a questionnaire. Approximately 50 young people were interviewed, and 293 youngsters completed the questionnaire. In terms of questionnaire responses, the greatest worry of the Soviet sample of youngsters was nuclear war, as almost 90 percent of the Soviet children regarded the prospect of nuclear war as disturbing or very disturbing. The Soviet sample was significantly more concerned about global issues, such as world overpopulation, world hunger, and pollution, while the American sample had significantly more concern about family and personal matters. Strikingly, the Soviet youth were more op- timistic than the American youth that a nuclear war would not occur during their lifetimes. In the Soviet group, three times as many youngsters felt positive about the possibility of preventing nuclear war than the American students did (75 compared with 25 percent). In general, Chivian and associates observed from their data that Soviet children reported that they learned about the facts of nuclear war earlier than American children and appeared to have consistently more detailed and accurate information than their American counterparts. There also appeared to be more discussion in families than in the United States. The Soviet youngsters were more pessimistic about the possibilities of survival if war occurred. Virtually all the Soviet children had taken part in officially organized peace edu . . . . cation activities. QUALITATIVE STUDIES While quantitative published reports of relatively large numbers of sub- jects provide important evidence, so do qualitative studies. There is increasing anecdotal evidence that at least some children under the age of 11 are seriously concerned about the possibility of nuclear war. Such evidence consists of videotaped discussions with children in public schools, as carried out by Chivian and Snow;24 anecdotal case reports from clinical material, as reported by Stoddard and Mack;2s and an in- creasing body of work from primary school teachers who have dealt with these subjects with their students.26 27 These qualitative investigations have established that at least some children under age 11 are concerned. It is undoubtedly true that this group represents a smaller percentage than those adolescents who are concerned. The meaning of this is even less well

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CHILDREN'S AD DESCENTS' PERCEPTIONS OF NUCLEI We 423 known than the meaning of results with adolescents. No data from a developmental point of view exist. In terms of qualitative interview studies, Goodman et al.28 conducted a pilot interview study with adolescents in the metropolitan Boston area. While such a small sample in no sense can be called representative, and although the youngsters were not selected because of their view of the nuclear question, interviews with these youngsters give an even more vivid and detailed sense of the meaning of the threat of nuclear war in their lives. Although some students reported that they try not to dwell on it, while others claimed that they worry about it constantly, all of the 31 adolescents asserted that the existence of nuclear weapons impinges on their lives on a daily basis. They reported that they are reminded of the arms race when they read the papers or watch television and that there is a constant worry in the back of their minds. These teenagers say they are afraid every day that nuclear annihilation will come, if not right away, then in a relatively short time. Some have planned to move away from the cities because of the threat; a few have decided not to have children, and they say that the threat of nuclear war has forced them to live more in the present. Most of these youngsters do not advocate unilateral disarmament and, given the current international political situation, feel that some nuclear weapons are necessary. However, a deep discouragement, a sense of things being out of control, pervades their perceptions of the arms race; they draw no sense of security or safety from the presence of the weapons. One student explained his helplessness this way: I don't have the power to control, to say whether to have bombs or not, I don't have the control to say whether we make nuclear weapons or not . . . I don't know what kind of thing would happen, but at any minute there goes the bomb. It scares me a lot, this kind of emptiness, this kind of hollowness, like being in a tunnel and having to fight and nothing is around you and you're clawing at everything trying to find something. That's the kind of feeling. From quite a different perspective, Robert Coles29 has reported some in-depth interviews with youngsters about the threat of nuclear war. These lasted several sessions over a period of time, as opposed to the interviews of Goodman and associates, which were one session each. His descriptions are eloquent; his conclusions are that it is largely, if not entirely, young people whose parents are upper class and who are involved in the nuclear movement who are deeply concerned about this. He specifically argues that lower class youth are not concerned and gives several anecdotal illustrations. He also raises the question that some youngsters may be putting on or pretending to be concerned about this issue and that, in any case, youngsters keep on with their usual activities in spite of this worry.

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424 IMAGES AND RISKS OF NUCLEAR WAR No description is given in Coles' report of how these youngsters were selected, how many were interviewed, and, from the number interviewed, how many were selected to be reported. Neither the length of the rela- tionship nor the way that the interviews were described to the children is given. Nonetheless, Coles' work emphasizes the importance of in-depth interviews over time and of understanding the full context of the child's experience in trying to understand the impact of the threat of nuclear war. DISCUSSION All of the quantitative studies discussed above concur in demonstrating that a significant number of youngsters report serious concern about the threat of nuclear war. Estimates of the percentage of those seriously con- cerned in the United States vary. Evidence from Bachman9 and others suggests that many more young people are seriously concerned about this threat than they were a few years ago. It is clear that young people in a number of different countries in several parts of the world share these concerns. Youngsters are primarily made aware of the threat of nuclear war through the media; this is sometimes supplemented by information in school. They report that they do not discuss these matters with their parents for the most part and often are alone with their fears. The meaning of these attitudes in the context of the youngsters' lives has been much less well investigated, and some critiques of the work have appeared.29-3~ Qualitative studies, such as the initial study by Mack and myself,7 our interview study,28 videotapes of youngsters, 24 family inter- views,32 and educators who have talked with classes about this issue,27 33 all suggest that the concerns for some young people are serious, and major, and are talked about with eloquence. Coles' interviews present a different picture, with much more class-limited areas of concern. However, the survey research of Bachman and associates9 ~0 argues strongly against the fact that concern about the future or worries about the fate of the world are class-bound phenomena. The reported seriousness of the youngsters' concerns is substantiated by studies such as those of Goldenring and Doctor. i3 ~4 Methodological Issues The study and understanding of the impact of the threat of nuclear war on the lives of children and adolescents is in an initial stage. This must be expected given the fact that so little work has been done over the last 20 years in this area and that so little research time and funding have been

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CHILDREN'S kD ~OLESCE=S' PERCEPTIONS OF NUCLEI We 425 directed to it. Perhaps most telling is the fact that there are no clear analogous areas of inquiry from other studies in social science that can serve as models. We have not begun to fully understand the impact on young people of attitudes and beliefs about the current society, or about their future in it in general, and so at this point it is impossible to parcel out and describe quantitatively and definitively the effect on young people of these attitudes toward the threat of nuclear war alone. Moreover, there are unique characteristics of this issue that make it difficult to study, as will be discussed below. Understanding these difficulties should assist further research, but it should also give a broader perspective on why so little work has been done.8 In terms of the specific limitations of the current studies that have been described above, while questions about the representativeness of the sam- ples have been adequately addressed in the survey studies, for example in Bachman's efforts,9 they have been less well addressed in some of the international studies. Goldenring and Doctor's impressive findings ~4 are based on systematic sampling, but in a very limited number of school systems in one area of the country, and thus require replication in other areas. The use of in-depth interviews and questionnaires in the United States and elsewhere have not yet been done on any serious systematic sampling basis. Given the difficulties of translation and the immense cultural differences between countries, quantitative comparison of youngsters in different, non-English-speaking countries to English-speaking youngsters, or to one another, must be viewed at this point as hypothesis generating rather than as definitive. However, the finding of serious concern in a substantial percentage of children in all countries surveyed is not called into question. As yet, no study of the impact of nuclear war on children and adolescents has demonstrated any serious psychopathological effects that have resulted from the threat, nor has any serious large-scale study even attempted that. There are a number of compelling individual anecdotal reports about distress25 34 resulting from the threat of nuclear war, but there is no quan- titative evidence on this question. More broadly, there is little evidence about the effects of the attitudes of these youngsters on actual behavior. They do, indeed, report that they are worried and that such worry has an effect, but studies of the effect have not been conducted. Little is known about the development over time of attitudes of children and adolescents toward the nuclear threat, although some data are available about the development of attitudes by youngsters toward war in general.35 There is evidence of differing perspectives when college students are compared with older adults.36 Recent studies of the responses of youngsters to war situations and extreme environmental stress37 may offer some

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426 IMAGES AND RISKS OF NUCLEAR WAR relevant analogies to approaches to understanding these impacts in general. From a research perspective, understanding the impact of the nuclear threat is complicated by the fact that the issue is only one of several complex, rapidly changing forces operating in our modern industrial so- ciety. Some of the attitudes and concerns that have emerged from inter- views questioning young people about the threat of nuclear war are pessimism about the future, fear, hopelessness, and the need to live in the present. These psychological phenomena probably are related to other factors as well. Such factors are the growth of technology itself, the changing pat- terns of family structure, broad disillusionment with the political system as evidenced by decreasing rates of voter participation, declining American prestige at home and abroad, and economic woes. It is difficult in studies to separate the role of the nuclear threat from these other social problems, but it is important to do so insofar as it is possible. Thus more research is needed. It should build on the existing research and be specifically addressed to defining the areas in which the impact of nuclear war influences the youngsters' attitudes and behavior and should be informed by the need to attempt to separate out the complexity of the factors involved. There is a need for detailed longitudinal prospective studies in systematically chosen samples, including evaluation of the in- fluence of the development, the vicissitudes, the changes, and the effects at various developmental epochs of awareness of the threat of nuclear war and concern about it on youngsters. Similarly, as Coles has suggested,29 attention to the context of the children's and adolescents' lives in relation to this concern is necessary. Related to this, surely, is the investigation of the development of possible differences between young women and young men in their attitudes. It would be especially useful to have in- depth interviews and questionnaires in the same samples followed over time. Surprisingly, almost no attention has been directed to studying what enables youngsters to cope well with the threat of nuclear war, perhaps because it is difficult to define what successful coping is. However, at the least, in two areas related to successful coping much more work is needed. The first of these is a more detailed description of how parents and children interact about this issue and what effects, if any, such in- teractions have on the youngsters. Initial work indicates that this is a rich and potentially rewarding area for exploration.32 The second is the sys- tematic evaluation of educational efforts to date, particularly the various curricula that have been developed. The intriguing initial findings of Gol- denring and Doctor,~3 ~4 Sommers and associates,~7 and others38 suggest that being better informed and aware is in no sense maladaptive and may

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CHILDREN'S AD ADOLESCENTS' PERCEPTIONS OF NUCLEI Win 427 be associated with good functioning. This also should be replicated, and then efforts should be directed to understanding it further. Zweigenhaft39 has presented preliminary evidence indicating a positive response to an educational program. This also needs much fuller investigation. It would be incorrect to conclude, however, that all that is needed is more research, or that we do not know much about this area because there are some methodological limitations in what we do know or because more systematic research is needed. In a few years, we have learned a substantial amount in several areas, and that process is important and has implications both for research and for dealing with youth about this issue. These areas are the characteristics of the nuclear issue, the feelings engendered in those who become involved, and the implications for education. Characteristics of the Nuclear Issue The nuclear issue is an issue which reflects intense conflict among experts. It has provoked a polarization of political viewpoints. From a research perspective, this makes it difficult to obtain the necessary distance and objectivity to evaluate its effect fully and to understand young people's concerns. In terms of dealing with young people, it is also important to recognize that there are distinct characteristics of this issue that set it apart from other social and political problems. It is important to be aware of these in conceptualizing the task young people face in understanding this issue. The nature of the threat of nuclear war is at the same time abstract, outside of the personal experience of adolescents, and yet overwhelming in its horror and scale. Only twice has a nuclear weapon actually been used, on Hiroshima and Nagasaki. At no time has a large-scale nuclear war taken place. There is substantial disagreement among experts on what the consequences of such a war would be. To contemplate the threat of nuclear war requires an act of the imagination which is difficult, if not impossible, for most adults. It requires young people to venture into an unknown and uncertain territory, into which many of the adults around them will not travel. There has been an understandable though unfortunate tendency on the part of adults and society as a whole to keep these matters secret. 40 Nuclear weapons were initially developed during World War II, when debate was not possible. The prevailing attitude since then has been that further weapon development was largely a matter best left to scientific experts. It is not correct simply to attribute this silence to governmental policy. The subject is so painful, frightening, and seemingly technically impenetrable that

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428 IMAGES AND RISKS OF NUCLEAR WAR most adults have chosen to deal with it by denial and avoidance. 4~-43 Until recently there has been virtually a total lack of public discussion of nuclear weapons issues. Feelings Engendered in Those Who Become Involved: A Painful Awareness To work with the subject of nuclear annihilation is painful and difficult for everyone researcher, clinician, parent, or child. To consider seri- ously the possibility of nuclear war is to contemplate the destruction of life as it exists on the earth. It means the end not only of one's own life, but of the lives of everyone we love, indeed of all relationships which exist, possibly forever. It is a horrifying idea, the vision of a holocaust unlike anything the planet has known. Moreover, it is not clear that any one citizen can do very much by him- or herself about the problem, so that there is an attendant helplessness as one confronts its reality. Thinking that a nuclear war will occur obviates thinking about the future. For adults, thinking about children and nuclear war is a particularly difficult task. Children one's own or anyone else's are far more vul- nerable than adults to the effects of nuclear war. Their futures' are poten- tially longer; their own children are yet to be born. Their genes, bones, and other tissues are more susceptible to the effects of radiation. For all of us, another part of the difficulty in achieving full awareness of the nuclear issue is the pain of realizing that one is potentially both victim and perpetrator of nuclear violence: victim because there is so little control over the weapons; perpetrator because those of us who are U.S. or Soviet citizens are members of countries that are spending huge amounts in tax dollars to build instruments of destruction whose sole possible use is to annihilate large portions of the human race. It is difficult for anyone to think about these matters, let alone know how to talk to or deal with young people about them. Beyond this, it is disturbing to think that the threat of nuclear war in and of itself might be having an impact on our children's development. Furthermore, the subject itself, precisely because it is so painful and yet so politically controversial, is inherently divisive. I do not wish to overdramatize the problem but to raise an issue which is something like countertransference in psychotherapy and psychoanal- ysis, the deeper thoughts and feelings which are evoked in the clinician by the case material before him. Special attention to these feelings has proved necessary in certain situations, such as dealing with patients with cancer or survivors of the Holocaust. 44 46 Such troubling emotions provide one of the major reasons that so little work has been done in this area,

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CHILDREN'S AD ~O~SCE=S' PERCEPTIONS OF NUCLEI We 429 but also provide experience in determining the need for the kind of help and education that young people need. IMPLICATIONS The Nature of Young People's Experience and the Need for Education The presence of nuclear weapons and the threat of nuclear war are major realities in our society today and will continue to be so in the future. Regardless of whether the percentage of youngsters seriously concerned at present is 30 or 40 or 60 percent, this represents a very large number of youngsters. That number is likely to increase. The data to date strongly indicate that young people are not receiving systematic education and open discussion about this immensely complex and difficult issue. Those that are concerned primarily find out about it through the media, and they are deeply troubled by what they find out. They are alone with their fears. It is certainly true that this issue of the immense destructiveness of nuclear weapons and the possibility of the destruction of the entire world is a crucial issue and must remain in the forefront of the issues considered in our democratic society. As yet, such full consideration generally has not taken place in the United States. In order for the democratic process to operate with regard to this issue, or any other, it is essential that citizens be informed and express their opinions. This issue has not drawn citizen participation, unlike many other issues, because it is so painful and difficult and because of the sense of powerlessness and helplessness it engenders. It is necessary to educate young people about this issue so that they can participate fully in the political process. The usual media presentation, whether print or visual, is a partial and incomplete way for youngsters to become educated about this issue. Most media presentations are not systematic or general discussions but are news items, focused on the particular subject of the day. They are often visually dramatic. This does not provide any systematic overview of the problems of nuclear issues; nor does it transmit to young people any sense of how to deal with nuclear issues, how to discuss them with others, or how to understand them. The exception to this are media presentations specifically focused on education, and some of these have been quite helpful. Beyond the media, most areas in which the nuclear area is touched upon in fiction, television drama, videogames of destruction, and so forth, are also partial and incomplete presentations at best. The way youngsters become aware

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430 IMAGES AND RISKS OF NUCLEAR WAR of the nuclear issues contributes to their helplessness and hopelessness. I have dwelt at length on the complexities of the issue and on the feelings engendered in those concerned with it because I think these are the issues that any citizen must wrestle with in coming to grips with the nuclear issue. I also believe that any young person in adolescence who is coming to grips with the nuclear issue must also wrestle with these matters, and they cannot be expected to do so alone. Youngsters must have help in doing so. As a psychiatrist, I am particularly aware of the workings of the mind, or inner processes, that accompany outward actions and changes in behavior It is essential that some attention be made to these inner processes or that people work through the fears and implications of the threat of nuclear war so that we can deal with young people about this threat. There is a great need for more systematic education. The work carried out to date gives us a clear idea of what kind of education is needed. I think there are two issues in education: what the content should be and to whom it should be directed. This education should be directed to those young people who have become aware of the issue and who are womed about it. I think, more broadly, there is a need for all adolescents to have some education about this issue so that they can be introduced to it. With regard to the content, education for youth should be systematic, not partial or incomplete. Partial accounts are frightening and may turn youth away. It is essential that young people not be left alone with their fears. It is essential that they make contact with others who are willing to hear them and to share their concerns. Education must take place in a context, that is, in a relationship which allows back and forth questioning and which also takes place over time. The context may be provided by school, media presentations with follow-up discussions, parents, doctors, educators, or others. What is necessary for those providing the education is knowledge of the issue, sensitivity to the inner processes of working through the painful feelings engendered, and a willingness to try to come to grips with what the youngsters are voicing. This means that people doing the educating must have learned to deal with the issue themselves to some extent. It is no accident that the Edu- cators for Social Responsibility program, under the leadership of Roberta Snow in Boston, was developed from a program in the Brookline Public Schools for Teaching History in Ourselves, which dealt with the question of the Holocaust.33 Teachers found that they could not teach students about the Holocaust, without some preparation and support for themselves, because it is so horrifying an historical subject. Likewise, teachers have found that such preparation is necessary for teaching students about the threat of nuclear war. Similarly, it has been recommended to parents and

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CHILDREN'S AND ADOLESCENTS' PERCEPTIONS OF NUCLEAR WAR 431 mental health professionals that it is necessary for them to work on their own feelings about the issue before they deal with it with others. ~ 47 These are examples of how those who have worked in the area have had to deal with the issue themselves first. The most important component of education is making youngsters aware that they are not powerless, that their actions are important and that they do make a difference on this issue, as on other issues in a democracy. From a psychological point of view, the central psychological concomi- tants of partial and incomplete awareness of the nuclear issue are help- lessness and hopelessness, which often lead to inactivity, to paralysis. It is essential to counteract these feelings through education to help young people become aware that they are not powerless. Indeed, from a psy- chological point of view, some corrective focus is necessary for the sense of helplessness engendered by this issue, and action can be very beneficial. By action, of course, I do not mean getting involved in political action per se, but rather being educated, talking with others. coming to grins with the issue in an inner sense. Concern with young people's attitudes is not an idle, speculative, or irrelevant matter. I believe it is likely that the declining involvement of youth in the political process is in part related to the perception that the threat of nuclear war is frightening and that little can be done about it, so involvement is useless. Yankelovich,48 Offer, 49 and others have argued that the current generation of adolescents is considerably less hopeful and more pessimistic than previous ones and that this is not confined to any one social class. While it is difficult to quantify and neatly parcel out the relative effects of these various forces that lead to this pessimism, the nuclear threat and the immense amounts of energy and money expended on the nuclear arms race is a fundamental part of our society and surely contributes substantially to an overall sense of hopelessness and pessi- mism. HOPE AND THE FUTURE Nuclear war is not inevitable. The actions of individuals and groups are not insignificant or unimportant in trying to prevent a nuclear war. While we may differ enormously about whether more weapons or fewer will more successfully prevent a nuclear war, we agree on the need for its prevention. As M. B. Smith has commented, 50 it is the responsibility of one gen- eration to be able to transmit a vision of the future to the next. I am deeply concerned that our understanding of the nuclear issue and its impact on youth suggest that it weakens or diminishes the vision of hope for the

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432 IMAGES AND RISKS OF NUCl:FAR WAR future of a substantial number of youngsters. It is, after all, Sue that the prevention of nuclear war rests not only on our current generation, on ourselves, but also on our children's generation, on them. They will have to make this a central issue of their lives. This can only occur when they are fully informed and carefully introduced to the issue, supported in their understanding of it, and then willing to take action. This can occur only when they have a vision, a hope for the future, which includes the belief that nuclear war can be prevented and that their actions have an effect. This must be the central aim of our educational efforts. NOTES ~Escalona, S. 1965. Children and the threat of nuclear war. In Behavioral Science and Human Survival, M. Schwebel, ed. Palo Alto, Calif.: Science and Behavior Books Inc. 2Schwebel, M. 1965. Nuclear cold war: Student opinions and professional responsibility. Pp. 210-223 in Behavioral Science and Human Survival, M. Schwebel, ed. Palo Alto, Calif.: Science and Behavior Books Inc. 3Adams J. F. 1963. Adolescent opinion on national problems. Personnel Guidance J. 42(4):397-400. 4Allerhand, M. E. 1965. Children's reactions to societal crises: Cold war crisis. Am. J. Orthopsych. 35: 124- 130. sWrightsman, L. 1964. Parental attitudes and behaviors as determinants of children's responses to the threat of nuclear war. Vita Humana 7:178-185. 6Darr, J. M. 1963. The impact of the nuclear threat on children. Am. J. Orthopsych. 33:203-204. 7Beardslee, W., and J. E. Mack. 1982. The impact on children and adolescents of nuclear developments. In Psychosocial Aspects of Nuclear Developments, Task Force Report Num- ber 20. Washington, D.C.: American Psychiatric Association. ~Beardslee, W. R., and J. E. Mack. 1983. Adolescents and the threat of nuclear war: The evolution of the perspective. Yale J. Biol. Med. 56:79-91. 9Bachman, J. 1983. American high school seniors view the military, 1976-1982. Armed Forces and Society 16(1):86-94. Johnston, L., J. Bachman, and P. O'Malley. Monitoring the future: Questionnaire responses from the nation's high school seniors 1975-83 (annual volumes). Ann Arbor: Institute for Social Research. ~Gallup, G. 1984. The Gallup youth survey, released October 17, 1984, Associated Press. '2Offer, D., E. Ostrov, and K. I. Howard. 1986. Normal adolescents' concern with nuclear issues. Unpublished manuscript. Michael Reese Hospital and Medical Center, Chicago, Illinois. ~3Goldenring, J. M., and R. M. Doctor. 1983. Adolescent concerns about the threat of nuclear war. Testimony for the House of Representatives Select Committee on Children, Youth and Families, U.S. Congress, September 20, 1983. ~4Goldenring, J. M., and R. Doctor. 1981. California adolescents' concerns about the threat of nuclear war. Pp. 112-133 in Impact of the Threat of Nuclear War on Children and Adolescents, T. Solantaus, E. Chivian, M. Vartanyan, and S. Chivian, eds. Boston: International Physicians for the Prevention of Nuclear War.

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CHILDREN,S AD ~OLESCE=S' PERCEPTIONS OF NUCLEI We 433 l5Solantaus, T., M. Rimpela, V. Taipale, and O. Rahkomen. 1981. Young people and the threat of war: Overview of a national survey in Finland. Pp. 94-103 in Impact of the Threat of Nuclear War on Children and Adolescents, T. Solantaus, E. Chivian, M. Var- tanyan, and S. Chivian, eds. Boston: International Physicians for the Prevention of Nuclear War. ~6Solantaus, T., M. Rimpela, and V. Taipale. 1984. The threat of war in the minds of 12-18 year aids in Finland. Lancet 8380(1):784. Summers, E., S. Goldberg, D. Levinson, C. Ross, and S. LaCarbe. 1981. Children's mental health and the threat of nuclear war: A Canadian pilot study. Pp. 61-93 in Impact of the Threat of Nuclear War on Children and Adolescents, T. Solantaus, E. Chivian, M. Vartanyan, and S. Chivian, eds. Boston: International Physicians for the Prevention of Nuclear War. Affray, B., and J. J. Valentine. 1981. Nuclear war: The knowledge and attitudes of New Zealand secondary school children. In Impact of the Threat of Nuclear War on Children and Adolescents, T. Solantaus, E. Chivian, M. Vartanyan, and S. Chivian, eds. Boston: International Physicians for the Prevention of Nuclear War. ~9Holmborg, P. O., and A. Bergstrom. 1981. How Swedish teenagers think and feel concerning the nuclear threat. Pp. 170-180 in Impact of the Threat of Nuclear War on Children and Adolescents, T. Solantaus, E. Chivian, M. Vartanyan, and S. Chivian, eds. Boston: International Physicians for the Prevention of Nuclear War. 20DeJong, J. 1981. Teaching about nuclear weapons. Presented at Institute of Polemology, University of Groningen, Groningen, The Netherlands, June. Richter, H. E. 1982. Psychological effects of living under the threat of nuclear war. J. Royal Coil. Gen. Practitioners June:377. 22Tizard, B. 1984. Problematic aspects of nuclear education. In A special issue: Education and the threat of nuclear war. Harvard Ed. Rev. 54(3):271-281. 23Chivian, E., J. E. Mack, J. P. Waletsky, C. L. Lazaroff, R. Doctor, and J. Goldenring. In press. Soviet children and the threat of nuclear war: A preliminary study. Am. J. Orthopsych. 24Chivian, E., and R. Snow. 1983. There's a nuclear war going on inside me (a videotape of interviews with 6-16 year olds). Boston: International Physicians for the Prevention of Nuclear War. 25Stoddard, F. J., and J. E. Mack. 1985. Children, adolescents and the threat of nuclear war. In Basic Handbook of Child Psychiatry, Vol. V, J. Noshpitz, ed. New York: Basic Books. 26Friedman, B. 1984. Preschoolers' awareness of the nuclear threat. Calif. Assoc. Ed. Young Children Newsl. 12(2). 27Engel, B. S. 1984. Between feeling and fact: Listening to children. Harvard Ed. Rev. 54(3):304-314. 28Goodman, L., J. E. Mack, W. R. Beardslee, and R. Snow. 1983. The threat of nuclear war and the nuclear arms race: Adolescent experience and perceptions. Polit. Psychol. 64(3):901-930. 29Coles, R. 1985. The Moral Lives of Children. Boston: Atlantic Monthly Press. 30Smith, M. B. 1982. The threat of nuclear war: Psychological impact. Address at the Physicians for Social Responsibility Symposium, Eugene, Oregon, October 9. embower, B. 1985. Kids and the bomb: Apocalyptic anxieties. Science News 128:106- 107. 32Zeitlin, S. 1984. What do we tell mom and dad? The Family Therapy Networker 8(2):31ff.

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434 IMAGES AND RISKS OF NUCLEAR WAR 33Snow, R. S., and L. Goodman. 1984. A decision making approach to nuclear education. Harvard Ed. Rev. 54(3)321-328. 34Koupernick, C. 1967. Refusal of an adolescent to accept the modern world. J. Child Psychol. Psych. Allied Disciplines 8:233-240. 35Kahnert, M., D. Pitt, and V. Taipale, eds. 1983. Children and war. Geneva, Switzer- land: Geneva International Peace Research Institute. 36Van Hoorn, J., and P. French. 1985. Facing the nuclear threat: A cross-age comparison. Presented at American Educational Researchers Association, April. 37Garmezy, N., and M. Rutter. 1985. Acute reactions to stress. Pp. 152-176 in Child and Adolescent Psychiatry: Modern Approaches, M. Rutter and L. Hersov, eds. Boston: Blackwell Scientific Publications. 38Eisenbud, M. B., J. Van Hoorn, and B. B. Gould. In press. Children, adolescents, and the threat of nuclear war: An international perspective. In Advances in International Maternal and Child Health, Vol. 6. 39Zweigenhaft, R. L. The psychological effects of living in the nuclear age. Report of the War Planning Evaluation Committee, Greensboro-Guilford County, Greensboro, N.C. 40Carson, D. I. 1982. Nuclear weapons and secrecy. In Psychosocial Aspects of Nuclear Developments, Task Force Report Number 20. Washington, D.C.: American Psychiatric Association. 4iBernard, V. W., P. Ottenberg, and F. Redl. 1965. Dehumanization: A composite psychological defense in relation to modern war. Pp. 6~82 in Behavioral Science and Human Survival, M. Schwebel, ed. Palo Alto, Calif.: Behavioral Science Press. 42Mack, J. E. 1984. Resistances to knowing in the nuclear age. Harvard Ed. Rev. 54(3):260 270. 43Frank, J. 1967. Sanity and Survival: Psychological Aspects of War and Peace. New York: Vantage Books. 44Weisman, A. D. 1972. On dying and denying: A psychiatric study of terminality. New York: Behavioral Publications. 4sKubler-Ross, E. 1970. On Death and Dying. New York: MacMillan. 46Bergmann, M. 1982. Recurrent problems in the treatment of survivors and their children. In Generations of the Holocaust, M. Bergmann, ed. New York: Basic Books. 47Schwebel, M. 1982. Effects of the nuclear war threat on children and teenagers: Im- plications for professionals. Am. J. Orthopsych. 52(4):608-618. 48Yankelovich, D. 1982. Changing social values. Research Workshop in Preventive As- pects of Suicide and Affective Disorder in Young Adults. Harvard Medical School and Harvard School of Public Health, Boston, December 3. 490ffer, D. 1982. Adolescent self-image: Empirical studies and theoretical implications. Cambridge Hospital Symposium on Self-Esteem, Boston, December 10. 50Smith, M. B. 1983. Hope and despair: Keys to the sociopsychodynamics of youth. Am. J. Orthopsych. 53:388-399.