COMMENTARY

Through a Different Lens: A Mother's Day Lament

Karen Donelan, ScD

Disclosures

July 12, 2004

When I was first asked to write an editorial about the Thompson and Yokota paper on movie ratings,[1] I did what any self-respecting survey researcher who studies consumers would do. I read the paper carefully, looked at the Web sites, searched for other articles and papers, and assessed the available polling data. I thought this paper represented serious and important work in gathering data from multiple sources, trying to make sense of information that consumers have available, and helping to understand the variations. Industry ratings, they find, are a blunt instrument, an imperfect guide with only 4 or 5 points on the rating scale. How can such a simple scale capture the complexity of the fabric of all violence, sex, and language in films? It makes some sense to me to dig behind those numbers and compare the data from other independent sources (if such entities can truly exist).

But as a researcher I don't necessarily trust the generalizability of my own instincts and analysis, so I look for data. A Kaiser Family Foundation series of fact sheets presents information from several national studies on kids and the media. Nine out of 10 parents think ratings are a good idea, 84% say they actually use them, only about 54% of parents found them "very useful." A 2003 poll by Penn, Schoen, and Berland indicates that 78% favor universal media ratings as Thompson, Yokota, and others have proposed, and 70% want an independent group to do the ratings.[2] As a parent, I can confess, despite my love of data, that timely availability is everything -- I don't go online to review more detailed ratings, I don't look in directories at the video store; I do look at the DVD or video box for the description and rating and try to remember what other people have said about the choices. And I do find it helpful to know that the PG or PG-13 is for violence, language, or sex -- mostly because of what makes for a comfortable family viewing experience for a family where age differences create multiple layers of complexity in deciding what is tolerable and appropriate. Thank goodness for heartwarming sports stories when time is the enemy and the movie you go to find is often gone and you have to find an acceptable alternative before it's too late to go home and watch.

In the midst of this more intellectual pursuit of my own opinion, I called a halt to this line of inquiry. In some ways, that is unfortunate because I love thinking about how to educate and challenge consumers to be analytical about their healthcare and its quality, and this effort to think about the use of ratings could provide interesting models.

Here is what happened. Over a series of days, I was bombarded by images that I knew were part of the nasty secrets of former wars. On a daily basis for months now, we come face to face with forces of evil and destruction. Public executions, bodies in flames, mass casualties, attacks from the sky, crumpled buildings, murdered children. We have almost become accustomed to the bombings and dust. And then came the naked bodies, the sexual humiliation, the underwear, the executioner, the promise and reality of retribution in the beheading of a young man in the wrong place at the wrong time.

Who did not know that rape and sexual torture are part of war? Who did not know that humans are sometimes perversely delighted under the right kind of stress? Who among us, especially in medicine and public health, does not know the vulnerability of the naked human body exposed to the power and control of the one who holds the clothing or the tools of injury?

What mother does not weep when seeing another's child so exposed to the world? What mother does not understand from the time a child arrives in the world unclothed just how vulnerable is the human frame?

Where are the ratings for this nonfiction? If you want to protect your children from these images, you must grab the mail first (even when a special birthday gift is expected), keep the television off, hide the newspaper, turn off the radio in the car, avoid the sermons at church, stop talking to your friends on the phone when the kids are still awake, and decide to home school your children.

There is nowhere to hide, it seems, and there are no ratings data for the news at 5, 6, 7, noon, 4, 5, 6, 7, 10, and 11.

Here in Massachusetts, where I live, in some ways this is only the continuation of months of the miserable realities of what human beings can do to other human beings when power and authority run amok. The tragedy of the secret abuse of young children at the hands of clergy has been brought forth day after day for month after month in excruciating detail. Hundreds of children suffered in silence with no images to document the horror their words could not bring others to understand.

In this time of war, then, we know the power of the image and the satellite and we are not sure what to think of the person who holds the camera so that we may see for ourselves and know too well what happened.

We read that the ratings of film are somehow creeping, encompassing more profanity, sexuality, and violence as if we could somehow hold time still against the tide of prevailing culture. Not a decade ago at the Harvard School of Public Health, we debated whether condom advertisements could ever be shown in prime time, even in an AIDS epidemic. Now, every time I watch a Red Sox game with my 13-year-old son, we see multiple showings of commercials about erectile dysfunction and hear the caution to seek emergency care if you experience the negative side effect of a 4-hour erection. I remember how terrible it was to see ads about "feminine protection" when I was 13 and watching TV with my dad, and I can only imagine what it must be like to become a teenager today and just try to sort out normal and abnormal human sexuality in an era of Viagra, Cialis, sexual abuse by priests, Kobe Bryant, Michael Jackson, and others. From the military to the basketball court, the confessional to the stage...it seems we are more than "creeping" forward...but culture does seem to accelerate in the eyes and minds of those past 40.

How do we protect our children? Tell them to go out and play on the playground? Keep them away from the news? Put filters on the Internet provider and the cable boxes? Install metal screeners at their schools and police guards on their buses? Send them to church? Tell them to ask the police or military personnel for help? Can we counteract the erosion of trust that comes when children are shot in schools and on playgrounds, when they are sexually assaulted on school buses and in churches, when they see their heroes in sports and drama and the military for the frail and imperfect and cruel human beings they might be? Can we inoculate them with information and analysis?

Physicians and nurses, listen to your patients to get some answers. Those who love science and evidence and data are always frustrated by surveys from patients that demonstrate the high value people place on compassion, respect, and bedside manner. Those patients for whom science and data offer little or no hope can tell you this -- the people you trust are those who treat your feeble human frame with dignity when the human body is exposed and vulnerable. Competence and skill matter, but so do simple acts of human kindness -- the touch that comforts and doesn't hurt, the words that soothe without offense, the respect for culture and language and religious practices that may at first be new or different.

This heart aches today to see those images for general audiences.

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