The simple answer to this question is yes but it’s not what you think. According to the most recent reports from both the National Alliance on Mental Illness (NAMI) and Mental Health America the rate of serious mental illness in both adults and teens is rising. In 2024, mental illness was experienced by 23.4% of adults and 16.5% of youth aged 6-17. Serious mental illness was experienced by 5.6% of adults. The disorders reported with the highest frequency in adults were anxiety disorders (19.1%), major depressive disorders (15.5%), and co-occurring substance use disorders and mental illness (8.1%). (Reinert, Nguyen, & Fritze, 2025; National Alliance on Mental Illness, n.d.)  How do these numbers compare with medical conditions? Nearly 50% of Americans have high blood pressure which if untreated is a precursor to disability and death. (Essa et al., 2025; Wadhera et al., 2026) The rate of diabetes in Americans is 14% and the rate of obesity is greater than 40%. (Wadhera et al., 2026)

It is extremely difficult to accurately interpret the rates of mental illness for a variety of reasons. Much of the data comes from the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health. (Substance Abuse and Mental Health Services Administration, 2025). Surveys can have significant limitations. While the SAMHSA survey produces a large sample size allowing statistical modeling to increase representation of the general population there are still many confounding factors. Participants self-select. The survey is made available to a large number of individuals but those who choose to participate want to make time to complete this survey, that is close to 800 pages and share very personal information about their use of substances and their mental health. Some participants may also be invited to complete an interview. Many of those invited to participate are not interested. This may result in some bias in the sample. Self-reporting is not always accurate and certainly not the same as gathering data from medical records. This questionnaire asks many screening questions related to diagnostic criteria for specific mental illness diagnoses. Screening tools are just that. By themselves they are not diagnostic and require further evaluation in the form of an interview by a trained mental health professional in order to make a diagnosis. When a person reports experiencing “serious mental illness” in the past year, what does that mean? Does it require having a specific diagnosis, was the diagnosis made by a qualified mental health professional, and was the diagnosis accurate? Or is this a self-report of what a person thinks they may have based on their own research?  From the perspective of how the symptoms affect a person’s life, it doesn’t matter, because their life experience is valid. However, when it comes to understanding the symptoms, what may be causing them, what to call them, and treatment interventions, it may make a significant difference.

Another limitation of the SAMHSA survey is that it does not collect information from people who are homeless (not living in a shelter), on active military duty, or confined to an institution (jails, prisons, hospitals). Significant mental illness and substance use disorders are over-represented in the institutionalized and homeless populations, making the survey data even more difficult to interpret.

It is very challenging to determine whether there has been a significant increase over the last decade in the diagnoses of major mental illnesses like major depression, anxiety disorders, bipolar disorder, or psychotic disorders like schizophrenia for the same reasons the survey data are difficult to interpret. I have worked in the mental health field for over 40 years and while I do see increases in these diagnoses over time, they are not large. As we improve our knowledge and diagnostic capabilities and more individuals have access to mental health care it would be normal to see some increase in these diagnoses over time.  If diagnoses of major mental disorders are relatively stable, why do many believe there is a major mental health crisis in the United States? There is, we are just looking in the wrong place.

                     X—–crisis—- -X

Mental Illness                               Mental Wellness                        Optimal Mental Health

Like physical health, mental health is on a spectrum. It is not static, but very fluid. Those with diagnoses of serious mental illness will be located somewhere to the left of mental wellness and when their symptoms interfere significantly in daily life, they will be at the far left. Optimal mental health, at the far right, is a place of awe, when there is a temporary reprieve from life stressors and everything is going right. Generally, striving for mental wellness in the middle is a good goal.

We tend to pay far more attention to medical rather than mental illness. There has been tremendous stigma surrounding mental illness and while we have made progress there is still much work to be done. It is important to remember that our physical health affects our mental health and our mental health affects our physical health. Our brains live in our bodies so what affects one also affects the other. Things we do to improve physical health will generally also improve mental health and vice versa. Things as simple as sleep schedule, diet, exercise, and making space for enjoyable activities can have a profound impact on our health if they become dysregulated or are absent.

When most people think about a mental health crisis in the United States, they tend to focus on the far left of the scale where serious mental illness lives. However, the current crisis actually occupies the space between mental illness and mental wellness regardless of whether an individual has a mental health diagnosis.

I am not discounting significant mental illness or it’s treatment, but the real crisis is more about lack of general mental health self-care and adaptive coping skills. There are non-pharmaceutical interventions with decades of research support, that improve and promote mental wellness including regular exercise, yoga, mindfulness meditation, spending time in nature, and using music and art as therapy.  There are also a number of approaches to therapy that can be very helpful including Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Eye Movement Desensitization and Reprocessing (EMDR) for trauma work, just to name a few.  In the current climate of pharmaceutical domination, these interventions are being discarded in favor of accumulating multiple mental illness diagnoses and polypharmacy. Many of these medications have serious and sometimes irreversible side effects and questionable efficacy.

I am not against the use of psychotropic medications. I prescribe them in my clinical practice. They can be very beneficial and in some cases lifesaving. However, in most cases medication alone is never an effective management strategy. Let us take a look at an example. A teen or adult is struggling with significant anxiety about how others perceive them and is bombarded by negative intrusive thoughts and self-talk that interfere in multiple areas of their life. At school or work they are sure others view them negatively making it difficult to engage with classmates, teachers, or coworkers and interfering with performance of tasks. When they get home after school or work, they spend time mentally reviewing each interaction of the day in excruciating detail, being especially critical of what they did or said and interpreting all responses negatively. Their only friends are people they met online and have never met in person. They have a small group of online friends who also struggle socially and as a group they spend time discussing how mean other people are. They also spend hours on social media, doom scrolling other people’s accounts, comparing their life to their perception of others based on the content posted. They may try to quiet their anxiety with food, alcohol, or other substances. They sleep poorly due to intrusive and racing negative thoughts and disturbing dreams and they have chronic thoughts they would be better off dead although no motivation to act on these thoughts. They also experience headaches and stomach aches, especially in the morning before leaving for school or work and if they need to interact with others at social events. This can result in missing days of school or work and declining invitations to social events.

The teen or adult is seen by a mental health provider and diagnosed with an anxiety disorder. They are started on a selective serotonin reuptake inhibitor (SSRI) such as Prozac, Zoloft, or Lexapro. These psychotropic medications are the first line treatment for anxiety and depressive disorders. How long will it take for medication to work and what level of relief will they receive? SSRIs can take up to several months to begin providing significant symptom relief. Research indicates about 60% of people who take an SSRI have a response, meaning they notice 50% improvement in symptoms and only 40% achieve remission. There is also concern about a modest placebo effect confounding the evaluation of efficacy. (Furmark et al., 2025; Belanger et al., 2023) If the teen or adult has a response to medication will it completely eliminate anxiety, negative intrusive thoughts, physical symptoms, improve sleep, decrease substance use, and improve confidence in social situations? The honest answer is no.

An SSRI may decrease their overall level of anxiety and physical symptoms and slow down negative thoughts but it will not make them go away.  These modest improvements may provide some relief but most likely will not have an effect on behaviors used to cope with anxiety. Ruminating on negative thoughts, isolation, doom scrolling, and use of food and substances to manage anxiety are all maladaptive behaviors that have been used long term and reinforced on some level. Without intense work in therapy, they are likely to continue. The work of therapy in this case is to examine these behaviors and how they affect the teen or adult, prioritize where to start, and begin by learning some new coping skills that are more adaptive, before trying to reduce and eliminate some of these behaviors. The teen or adult can learn to challenge negative thoughts and use distraction techniques to prevent rumination. They can find ways to gradually expand their social circle to reduce isolation. They can replace doom scrolling, overeating, and substance use with more adaptive coping skills. It is not easy work and it requires examining things about oneself that are often painful. It also takes time and motivation but, in the end, these are skills that will decrease anxiety and improve all areas of daily life, helping the individual learn how to help themselves.

What led to this dearth of adaptive coping skills in America? Some of it is related to changes in the pace and stress of life and how this has affected family structure and function. And some of it is related to the growth of the internet, social media, AI and access to these. Yes, I am going to play that card and I will explain why in a moment.

A brief review of traditional child development tells us that until a child goes to school their world is shaped primarily by parents, caregivers, and other significant adults in their life. Their behavior and coping skills are developed by seeking attention and love from these caregivers and observing how these important people manage their own stress. Once children begin school, they have the additional influence of teachers, peers, and friends. In adolescence friends generally become much more important and influential than parents. The teen years are a time when personality, ethical and moral decision making, and personal values are all beginning to coalesce.

Think back to the time before computers, cell phones, and the internet were widely available in the United States (late 1990’s). When children were at home, they were not on their phone or other electronic device, so what were they doing? Talking with parents or caregivers, helping with chores, playing board/card games, coloring, completing puzzles, reading, playing with siblings, neighborhood kids, or friends, spending time outside in nature, and perhaps watching something on TV, keeping in mind how limited programming was at that time.

Teenagers were interested in maximizing time with friends. Since they could not connect on-line they either needed to use the family phone plugged into the wall before cordless models, so privacy was sometimes difficult to achieve or get together in person. They may have decided to participate in after school activities as a way to spend additional time with friends doing something enjoyable. But mostly, they had to find ways to spend time in person. Their exposure to information came from parents, teachers, friends, maybe the library, and the TV. It took longer for news to make it to the public, it was much more heavily censored than it is now, there was still some semblance of journalistic integrity, and it was not available 24 hours a day. This time spent in person helped with the development of adaptive and productive social skills as well as providing excellent social support. Engagement in a variety of activities also provided exposure to adaptive coping skills that could serve as a foundation for managing life stress into adulthood.

If we fast forward to today, much of our communication does not take place in person.  People do not write in complete sentences anymore and use many slang terms and abbreviations. No context is provided by visual cues like facial expressions, body language, and gestures. This leads to misunderstanding and uncertainty. People who are isolated often lose social skills that can create anxiety when they need to spend time around others. Communicating electronically also leads to immediate responses without thinking through potential consequences, which can produce awkward and destructive outcomes. These all contribute to tears in the fabric of society and a breakdown of effective communication.

In addition to the breakdown of social skills and communication the internet and social media access have exposed us to a tremendous amount of misinformation. A disturbing trend was developing pre-Covid in the tween and teen population. There was a dramatic increase in the glorification of mental illness on social media leading to the trend of diagnosis by social media. During Covid, this population was extremely isolated, and because they could not do much else, screen time soared. This combination seemed to increase the development of identity centered on mental illness, formation of on-line communities promoting these illnesses, and it dominated friend groups, often in a competitive nature to see whose symptoms were worse and who had the most diagnoses. It is disturbing to think that this population felt so disconnected the only way they could find validation was through identification as mentally ill.

Much of the mental illness information available on social media focused on symptom profiles which was problematic. There is tremendous overlap of symptoms in a variety of mental illness diagnoses as well as normal responses to life events. When things do not go as planned or desired, when we suffer a loss, or when we experience a traumatic event, we will have symptoms that can affect every aspect of our life and may last months. These are normal responses to life events and do not necessarily indicate mental illness. Perpetual happiness is a myth; it just does not exist. The more people strive to achieve this the more unhappy they become. Focusing on moments and mindful appreciation of interactions, events, and feelings throughout the day provides much more life satisfaction than striving for eternal happiness. Learning to validate our experiences and feelings, sit with distress, gather support, and use adaptive coping skills will sustain us through these difficulty life events.  Rarely can a pill match that.

Much of what is on social media and the internet is inaccurate at best and with the addition of AI it is getting worse. It is very challenging for people to distinguish fact from fiction. It is fine to do your own research, but then it is important to see a qualified health care provider to discuss your concerns, get accurate information, and make decisions about treatment that is right for you.

So how do we go from this?

Photo by Kathy Kroening. Lake Chelan, WA. November 2022

To this?

Photo by Kathy Kroening. Lake Chelan, WA. November 2022

If our aim is to improve the mental health of Americans, we have much work to do. We need to increase access to accurate information about mental health and wellbeing, especially for tweens and teens. Government funding for providing this curriculum in our school systems, starting in elementary school would be ideal. We also need to improve access to mental health care in the United States. Depending on the source, up to 10% of the American population has no health insurance. For those with insurance, depending on their coverage, they may have access to mental health care but not be able to afford it. Access is also affected by lack of providers. Mental health professionals are burned out and leaving the field and there are fewer individuals pursuing it as a career. Lack of mental health providers in rural areas in particular is a major barrier to accessing services. The bottom line is our government needs to take the lead and make changes that demonstrate they prioritize the health and mental health of all Americans. Without this declaration and actions to back it up, we will most likely continue to see decline.

On a personal level, each individual can focus on maximizing their own mental health and sharing what works for them with family and friends. In this way we can start a ripple that will hopefully gain momentum and spread to others. It is a humble start but you never know where it might lead.

Until next time stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Belanger, H, Lee, C, Poliacoff, Z, Gupta, C, & Winsberg, M. (2023). Early Response to Antidepressant Medications in Adults with Major Depressive Disorder: A Naturalistic Study and Odds of Remission at 14 Weeks. Journal of Clinical Psychopharmacology, 43(1): 46–54. https://pmc.ncbi.nlm.nih.gov/articles/PMC9803387/

Essa, M., Malik, D., Lu, Y., Yang, H., Spatz, E., Krumholz, H., & Faridi, K. (2025). Hypertension Prevalence, Awareness, and Control in US Adults Before and After the COVID-19 Pandemic. Journal of Clinical Hypertension (Greenwich), 27(7).  https://pmc.ncbi.nlm.nih.gov/articles/PMC12277530/

Furmark T, Wahlstedt K, and Faria V (2025) Revisiting the SSRI vs. Placebo Debate in the Treatment of Social Anxiety Disorder: the Role of Expectancy Effects, Neural Responsivity, and Monoamine Transporters. Frontiers in Psychology. https://pmc.ncbi.nlm.nih.gov/articles/PMC12104218/

Journal of the American College of Cardiology, 87(9). https://www.jacc.org/doi/10.1016/j.jacc.2025.12.027#abstract

National Alliance on Mental Illness (n.d.). Mental Health by the Numbers. NAMI. https://www.nami.org/mental-health-by-the-numbers/

Reinert, M, Nguyen, T & Fritze, D. (October 2025). “The State of Mental Health in America 2025.” Mental Health America, Alexandria VA. https://mhanational.org/wp-content/uploads/2025/09/State-of-Mental-Health-2025.pdf

Substance Abuse and Mental Health Services Administration. (2025). Key substance use and mental health indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (HHS Publication No. PEP25-07-007, NSDUH Series H-60). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/data-we-collect/nsduh-national-surveydrug-use-and-health/national-releases

Wadhera, R., Dhruva, S., Bikdeli, B., Bonaca, M., Kittleson, M., Ko, D., Lu, Y., Pagidipati, N., Sawano, M., Spatz, E., Vaduganathan, M., Wasfy, J. Young, C., Yang, H. Zheng, Z., Krumholz, H., & Curtis, L. (2026). Cardiovascular Statistics in the United States, 2026: JACC Stats.

In early January I was delighted to return to Kauai.  My husband and I love this island.  We were last there in the spring of 2019. At that time, he was four months post-chemotherapy for stage 3 non-Hodgkins diffuse B cell lymphoma. We did not know what his recovery would hold and we had not been to the island since 2012, so it seemed like the perfect place for us to regroup, relax, and start the process of recovery.

Photo by Kathy Kroening. North Shore, Kauai, HI. January 2026

This trip, we were joined by good friends for the first week.  Upon entering our rental condo, I went immediately to the lanai to take in the gorgeous ocean view, lush vegetation, and soothing sound of the crashing waves. I could feel myself start to relax on a very deep level that I seldom achieve. We enjoyed dinner at one of our favorite restaurants sitting outside in 70-degree weather. The travel day destroyed my lower back and hips which made for a terrible night’s sleep so although we were up much later than usual, I was up at 5:30am Kauai time the next morning. This might seem like a difficult start to a vacation but honestly it was amazing.  I sat on the lanai in the dark, drinking coffee, and listening to the waves.  As the sun rose and the birds began to sing, I felt truly blessed to have this 90 minutes alone with such beauty.

It is my routine at home to get up at 5:00am to write for an hour or two, even on long workdays, so I continued this pattern during our vacation. It was my gift to myself to have this time alone and enjoy the wonder of each blossoming morning. We visited familiar places, walked, talked, and soaked up the beauty and earth energy of the island.

What exactly is earth energy? What draws us to certain geographical locations and natural settings like the forest, mountains, or bodies of water? Why is this connection important? These were all questions circling my head during our two weeks in paradise. Two of my favorite places that have strong spiritual connections for me are Kauai and the Quinault Rain Forest/Olympic Peninsula in Washington State.

Both locations are culturally steeped in a history of respect and reverence for and cohabitation with nature. Kauai, known as the garden island, is Hawaii’s oldest main island having formed roughly five million years ago. It is not known for sure when the island was first inhabited but dates range from 250 to 1200 AD when visitors arrived by canoe from Tahiti and the Marquesas in the South Pacific. (Cook, 2023) Wahi Pana is a concept of great cultural significance to native Hawaiians. The term refers to sacred places that have spiritual power (mana) and are treated with great reverence and respect. The indigenous inhabitants were extremely diligent about preventing sea and land asset overuse consistent with the Native Hawaiian value of not desecrating the earth. While many Wahi Pana are associated with specific locations some can only be found when mind and soul are open to their discovery. (James, 2015)

Photo by Jeff Barreca. Waimea Canyon, Kauai, Hawaii. August 2000.

The Quinault Indian Nation consists of individuals descended from numerous indigenous groups including Cowlitz, Chehalis, Chinook, Quileute, Hoh, Queets, and Quinault. The Quinault Indian Reservation, located on the southwestern corner of the Olympic Peninsula, spans over 200,000 acres including forests, rivers, and 23 miles of Pacific coastline. The Quinault ancestors lived off the land and sea in harmony with nature and believed each generation was obligated to provide environmental protection and support all life dependent on it for seven generations. (Robinson, n.d.) The earth was a source of sustenance and great spiritual communion.

Photo by Kathy Kroening. Quinault Rain Forest. June 2021

This connection to nature has been studied and for research purposes has been given the name ecospirituality. The sterility of this term leaves me feeling detached so I will continue to use earth energy in this piece. Research demonstrates a strong spiritual connection to nature promotes physical, cognitive, and emotional health and wellbeing. (Billet, M., 2025; De Lorenzo et al., 2025) Spending time in nature a minimum of 120 minutes weekly has been shown to improve baseline health and wellbeing while visiting parks and forests reduces cortisol, improves heart-rate variability, and results in increased relaxation. (De Lorenzo et al., 2025)

There are several theories that may help explain the positive effects of this connection to nature. Kaplan’s Attention Restoration Theory (ART) suggests focusing on cognitive tasks for long periods of time leads to attentional fatigue and natural environments hold attention easily without requiring cognitive effort allowing for rest and recovery. Ulrich’s Stress Reduction Theory (SRT) proposes being in natural environments leads to experiencing positive emotions and activation of the parasympathetic nervous system decreasing physiological arousal and reducing stress. (De Lorenzo et al., 2025) Kellert and Wilson’s Biophilia Hypothesis proposes that humans are genetically predisposed to need and desire a connection with nature because it provides relaxation and healing. (Gaekwad et al., 2022).

Research suggests that walking barefoot in grass affects blood flow in the cerebral cortex causing activation of the parasympathetic nervous system and greater relaxation. (De Lorenzo et al., 2025) The same effect can be achieved through barefoot contact with natural materials, so generalizing this to include walking barefoot on the beach and in the surf can lead to changes in the brain and nervous system that produce relaxation.

Photo by Kathy Kroening. Princeville, Kauai, HI. January 2026

Shinrin-Yoku, or “forest bathing” became a popular preventive health care activity in Japan in the 1980’s. It incorporates mindfulness by focusing on all five senses while immersed in a natural setting. Research has shown that forest bathing improves immune function, cardiovascular and respiratory health, reduces depression and anxiety, promotes mental calming, and creates feelings of awe. (Hansen et al., 2017).

Photo by Kathy Kroening. Quinault Rain Forest, WA. June 2021

Photo by Kathy Kroening. Quinault Rain Forest, WA. June 2021

Research suggests that living near the coast improves quality of life and mental health because of stress reduction, better air quality, increased socializing, a more vigorous lifestyle, and feelings of spiritual connection with the ocean. (Nash et al., 2022). Although scientific studies may not prove the benefits of listening to and watching waves and walking barefoot in the sand, any beach lover will tell you it is calming, soothing, and mesmerizing.

Photo by Kathy Kroening. Kalaloch, Olympic National Park, WA. December 2017

Photo by Kathy Kroening. Anini Beach, Kauai, HI. January 2026

People have been photographing sunrise and sunset for as long as we have had photographic capability. Clearly humans find these markers of day and night visually appealing but is there something more happening. Research indicates that these events inspire awe which can lead to improved mood and produce positive emotions. (Smalley & White, 2023).

Photo by Kathy Kroening. Moclips, WA. June 2022

Photo by Kathy Kroening. Pacific Beach, WA. June 2024

In the last decade, research on emotional states has advanced and awe has been identified as a distinct emotion, arising in situations that exceed our usual frame of reference. Studies spanning 25 cultures document common experiences that are awe inspiring including exposure to the courage and kindness of others, nature, music, dance, art, and spiritual or religious practice. Several research studies indicate that awe has its own neurophysiological profile including reduced inflammation, increased oxytocin, increased vagal tone, and reduced sympathetic arousal leading to improved physical and mental health. In addition to this profile, awe also produces increased sense of meaning, prosocial behavior, social integration, and diminished sense of self. These can improve physical health by decreasing stress and somatic symptoms in the body, decreasing autoimmune disease symptoms, increasing cardiovascular health and longevity. They can improve mental health by increasing feelings of well-being, and decreasing stress, anxiety, depression, and symptoms of Post Traumatic Stress Disorder (PTSD). (Monroy & Keltner, 2023)

Photo by Kathy Kroening. Wailua Falls, Kauai, Hawaii. December 2012.

We are all descended from people who lived in harmony with the land and had great respect for mother earth. It is time to renew this relationship. The health benefits of earth energy are well established and accessible to anyone. Whether it is spending time in your own yard or garden, visiting local parks, or traveling to visit places that inspire awe, the key is to really approach these experiences mindfully, and fully engage all of your senses. Beyond the benefits of earth energy for our own health, now more than ever it is important for us to rekindle our love and respect for the planet we call home. We have lost sight of stewardship and sustainability with heavy costs in multiple areas. We can all become ambassadors for change by inviting others to share our passion for earth energy.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Billet, M., Baimel, A., Schaller, M., & Norenzayan, A. (2025). Ecospirituality. Current Directions in Psychological Science, 34(2). https://journals.sagepub.com/doi/10.1177/09637214241304326

Cook, C. (2023). Kauai: A History. Mutual Publishing.

De Lorenzo, A., Bertiotti, S., Giannotta, F., & Rabaglietti, E. (2025) Who Benefits from Barefooting? The Key Role of Baseline Wellbeing in Psychophysical Restoration. International Journal of Environmental Research and Public Health, 22, 1779.

Click to access ijerph-22-01779.pdf

Gaekwad, J., Moslehian, A., Roos, P., & Walker, A. (2022). A Meta-Analysis of Emotional Evidence for the Biophilia Hypothesis and Implications for Biophilic Design. Frontiers in Psychology, 13, 1-20.

Click to access fpsyg-13-750245.pdf

Hansen, M., Jones, R., & Tocchini, K. (2017). Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. International Journal of Environmental Research and Public Health, 14, 851.

Click to access ijerph-14-00851.pdf

James, V. (2015). Ancient Sites of Kauai: A Guide to Hawaiian Archaeological and Cultural Places.

Monroy, M. & Keltner, D. (2023) Awe as a Pathway to Mental and Physical Health. Perspectives on Psychological Science, 18(2), 309-320.

Click to access 10.1177_17456916221094856.pdf

Nash, K., van Putten, I., Alexander, K., Bettiol, S., Cvitanovic, C., Farmery, A., Flies, E., Ison, S., Kelly, R., Mackay, M., Murray, L., Norris, K., Robinson, L., Scott, J., Ward, D., & Vince, J. (2022). Oceans and Society: Feedbacks Between Ocean and Human Health. Reviews in Fish Biology and Fisheries, 32, 161-187.

Click to access 11160_2021_Article_9669.pdf

Robinson, S. (n.d.). Quinault Indian Nation: Living on the Edge. The Evergreen State College.  https://www.evergreen.edu/sites/default/files/Robinson%2520Quinault%2520case.pdf#:~:text=They,material%20and%20spiritual%20wealth%20to

Smalley, A. & White, M. (2023). Beyond Blue Sky Thinking: Diurnal Patterns and Ephemeral Meteorological Phenomena Impact Appraisals of Beauty, Awe, and Value in Urban and Natural Landscapes. Journal of Environmental Psychology, 86.

https://www.sciencedirect.com/science/article/pii/S0272494423000038

A glance at the news headlines can be a stressful and depressing way to start a day. Whether it is the Epstein files, the economy, ICE, Russia, Ukraine, The Middle East, Venezuela, China, Greenland, mass shootings, or destructive weather, gloom and doom dominate. For the average American, tension is high and confidence in the current administration making changes that improve our daily lives is low, resulting in chronic stress for many.

There is a substantial body of research that supports a link between chronic stress and illness. The mechanisms of action are complex but a key component is the hypothalamic-pituitary-adrenal axis (HPA). The hypothalamus and pituitary gland are structures in the brain and the adrenal glands sit atop the kidneys.  With increased stress, the hypothalamus starts a hormonal cascade that ends with the adrenal glands releasing cortisol, helping cells and systems in the body prepare to fight or flee. (Knezevic et al., 2023) Centuries ago, when we were further down the food chain, this was a very useful mechanism for survival. After evaluating a threat such as a predator, the flight or fight response allowed us to choose the action that was most appropriate for the situation and eliminate the stress.  Once this was done, the body returned to a state of homeostasis.

In our current world, most of the stress we experience is no longer a matter of literal life or death. Health issues can certainly create chronic stress on the body but most of the stressors we experience are psychological and emotional in nature and while they may feel like life or death situations the probability of causing death is low. However, this state of chronic stress produces sustained cortisol release ultimately resulting in desensitization over time. This can lead to increased inflammation in multiple systems in the body, decreased immune function, and other hormonal changes that can cause autoimmune disorders like rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), neurological conditions like Alzheimer’s and Parkinson’s Disease, psychiatric disorders like depression and anxiety, chronic pain disorders like fibromyalgia and migraines, and cardiovascular disease (CVD) including myocardial infarction and stroke. (Knezevic et al., 2023; Osborne et al., 2020)

While anyone experiencing chronic stress is at risk for the development of disease, women are at higher risk due to mid-life responsibilities and hormonal shifts. The changes women experience during perimenopause and menopause can significantly increase their risk of cardiovascular disease in particular.  There are a multitude of changes that can happen during this time that contribute to this risk including: early or premature menopause (less than 45 years of age); menopause as a result of bilateral oophorectomy (removal of both ovaries) without estrogen therapy; late peri-menopause and early menopause often leading to higher blood pressure, cholesterol, and triglycerides compared to other stages; disrupted sleep, hot flashes and night sweats linked with higher risk of CVD; lower estrogen levels; depression; increased lipids; metabolic syndrome; carotid atherosclerosis; weight gain; and central abdominal obesity. (Kaminska et al., 2023) While it may seem women at this stage of life are doomed when it comes to cardiovascular health there are many lifestyle choices and other factors that are protective. Genetics can certainly provide protection from CVD, but absence of family history does not create immunity. Eating a heart healthy diet, preventing excess abdominal fat, preventing obesity, regular physical exercise, avoiding nicotine, preventing or managing diabetes, and keeping cholesterol and blood pressure within recommended guidelines are all strategies that help reduce the risk of CVD. (Khoudary et al., 2020)

In addition to lifestyle modification, hormone replacement therapy (HRT) can be of tremendous benefit for women experiencing symptoms related to the menopause transition. Originally approved by the Food and Drug Administration (FDA) in the early 1940’s as a treatment for symptoms of menopause, HRT has had a tumultuous journey in the medical realm. When the findings from the Women’s Health Initiative (WHI) were made public in 2002, concerns about increased risk of breast cancer led to a sharp decrease in HRT. In 2003 boxed warnings were added by the FDA for HRT medications that included concerns about CVD, thromboembolism (blood clots), breast cancer, and possible dementia. Subsequent evaluation of the original WHI trials has linked the increase in breast cancer to use of medroxyprogesterone acetate, a formulation of progesterone that is not commonly used today. In addition, the original trials did not require initiation of HRT before age 60 and within 10 years of menopause. The reason this is significant is once a woman goes through menopause and loses the protective effects of estrogen, she is more likely to develop permanent vascular narrowing and hardening leading to CVD and clotting. This would confound the data from the study suggesting HRT caused these symptoms when in reality they were naturally occurring due to age and hormonal changes of menopause. Rather than causing the symptoms, HRT had no protective effects because it was started too late and the damage was already done.(Makary et al., 2025)

Recent reviews of prior studies and current research have led to new recommendations for HRT including starting before age 60 and within 10 years of entering perimenopause. A recent article in the Journal of the American Medical Association (JAMA) goes so far as to suggest that aside from antibiotics and vaccines, HRT may have the most positive impact on health outcomes in the population of older women than any other intervention. Long-term health benefits include reductions in fatal cardiovascular events (25-250%), bone fractures (50-60%), cognitive decline (64%), and risk of developing Alzheimer’s (35%). HRT can also help dramatically decrease symptoms of menopause including hot flashes and night sweats which improve sleep, cognitive function, and mood. Recent research suggests that starting HRT within 10 years of menopause reduces mortality by all causes in the following decade. (Makary et al., 2025)

Women can begin experiencing symptoms of perimenopause any time in their late 30’s to early 50’s with the cessation of periods usually happening some time in their 50’s. We have already discussed the health impacts of hormonal changes that take place during this entire transition, but what else is happening in the lives of women in their 40’s and 50’s that may contribute to increased stress? Many women are parenting during this stage of life. Some women are starting a family in their 40’s and others are launching children into adulthood, helping them with the transition to college or the work world. Needs vary depending on the age, number, and unique qualities of each child. Many women carry the bulk of parenting responsibilities. These include but are certainly not limited to feeding, clothing, scheduling and transportation to medical, dental, and vision appointments, tending to sick children, monitoring academics, communicating with schools, managing forms, fees, and transportation for extracurricular activities, monitoring electronic and social media use, setting boundaries, delivering discipline, and providing nurturing, love, and support. Parenting children with special needs magnifies stress. While rewarding, parenting is an incredible expenditure of energy, and it does not stop when children turn 18. Helping young adult and adult children navigate relationships, work, and parenting as they step into adulthood often consumes a significant amount of time and energy.

In addition to childcare, many women are working outside the home. Some jobs and careers provide little flexibility to accommodate parenting responsibilities, adding to stress. Job hours and requirements can also be incredibly challenging, depleting emotional and physical energy. Since many women are also responsible for the majority of daily household tasks including cleaning, shopping, cooking, and laundry, any time not spent in childcare, work, or household duties is most likely spent sleeping but it is one area that often gets sacrificed in order to perform other necessary tasks. As women age, they may also be providing care for grandchildren and for parents experiencing chronic health conditions and cognitive decline. This collision of caretaking responsibilities, work, and domestic duties with the hormonal changes that take place during perimenopause and menopause creates significant health and mental health risks for midlife women.

Given these assaults on health and mental health, what can women do to decrease stress and increase healing? Our role as caretakers often makes it difficult to honor and prioritize self-care but if we neglect it, resulting in compromised health, our ability to be present for others diminishes. It can also lead to frustration and resentment. Building routines that include space to be alone, time with friends, and inclusion of activities that nourish the soul promote optimal health and healing. Additional practices and skills that can facilitate healing include:

Learning to say no. While it is nice to be needed and declining invitations and requests can cause guilt, it is important to listen to your body and advocate for your own self-care needs even if it means saying no.

Learning to ask for and accept help. Many women pride themselves on being masters of multitasking and skillful problem solvers providing help to others but not needing it themselves. Doing it alone has significant consequences personally as well as relationally and learning to ask for and accept help can decrease isolation and resentment and increase connection.

Letting go of guilt and shoulds. Women often accept and hang on to guilt more often than men.  Some of this is self-imposed but some is assigned by others. There are times when examining guilt and decisions that should have been made leads to enlightenment, but more often this is unproductive and causes chronic feelings of negative self-worth. Releasing these thoughts and feelings can be freeing and decrease stress.

Taking news and social media holidays. Doomscrolling is dangerous. It is time-consuming and depending on the content you consume, it can leave you feeling depressed and stressed. With so many crises happening worldwide, the desire to stay well informed is understandable but allowing breaks can help reduce stress. These breaks may take the form of setting a time limit on news and social media consumption, skipping entire days, scanning headlines rather than reading entire articles, reading rather than watching or listening to news, and limiting discussion of hot topics with others.

Building community with other women. Women have unique ways of knowing and being in the world. Sharing these experiences can provide much needed acknowledgement, validation, nurturing, and support.

Exploring practices that promote centering and grounding. While a bit of research will uncover many recommendations it is important for each woman to find those that work for her. Considerations include time, cost, and the right fit with personality and interests. Some of these practices can be very simple and do not require anything other than building them into your routine while others require more planning and preparation. Things to consider when developing these practices include:

Making space. Balancing priorities can be challenging so it is important to create the space needed for self-care. Whether that space is for solitary activities or supportive time with friends, intentionally scheduling it increases the likelihood you will honor the commitment.

Focusing on moments. It is human nature to group and lump things together including daily experiences. At the end of a long and frustrating day it may seem like the entire day was negative and is labeled as a bad day. There is nothing wrong with this except it makes it easier to lump bad days into bad weeks into bad months and even bad years. The truth is there are most likely moments of joy, contentment, peace, and awe interspersed with the hardships. Pulling back, slowing down, being present, and focusing on moments can help gain a more balanced perspective.

Using the five senses. Many of us live in our heads, guided by thought, analysis, and inner dialogue. I have certainly been accused (and am guilty) of this for long periods of time, so I understand the difficulty of shifting perspective. In addition to being present in the moment, experiencing that moment using the five senses of sight, sound, smell, taste, and touch can broaden our awareness and enjoyment of our surroundings and situation.

Creativity.  Creativity engages a different part of the brain and often allows for the cessation of conscious, goal-directed thought that can be quite refreshing. Whether it is cooking, baking, quilting, sewing, crocheting, drawing, painting, playing music, dancing, listening to music, reading, writing, or other activities, making space for creativity can dramatically decrease stress and promote healing.  I have heard many people say they are not creative. I would argue we all have this ability, we just need to embrace and nurture it, allowing it to grow.

Calming the mind. Silencing the inner dialogue can seem overwhelming. We are so used to it we are often not even consciously aware of it. Practices like mindfulness, meditation, yoga, and prayer can help turn down the volume. Remember these are “practices” meaning it takes time to become part of your routine but if done regularly will help maintain a state of deeper calm.

Relaxing the body. Because our brains are in our bodies, they affect each other. Mental stress causes tension in the body that we may be unaware of. Activities like taking a warm bath or shower, floating (floating in salt water in a tank with restricted environmental stimuli), massage, and acupuncture can help reduce tension in the body, calm the nervous system, and lower the volume on that pesky inner dialogue.

Touch. The touch of others is a vital source of comfort and connection. Some people crave this more than others.  It is important to find safe and consensual experiences that provide much needed physical contact that run the gamut of touching, hugging, cuddling, holding hands, kissing, and making love depending on the context of the relationship.

Vibration. As a lifelong musician I have always been fascinated by the effects of vibration on the human body and mind. Singing produces vibration in the chest. Playing the cello produces vibration in the chest and abdomen but also the feet if you play barefoot on the right surface. Listening to music also produces vibration in the body.  A little over a decade ago, in my quest to expand my healing routine, I began looking for and experimenting with using vibration for healing. Chanting produces vibration in the chest while tapping acupressure points creates vibration in body tissues, both having a positive effect on the flow of energy. I use tuning forks and singing bowls in my self-care practice to unblock channels and keep the energy flowing freely.

Exercise. There is substantial research to support the benefits of regular exercise. Whether it is walking, hiking, running, cycling, swimming, weightlifting, or other activities, regular exercise not only improves physical health (improved cardiovascular and pulmonary function, improved immune function, optimizing flexibility, strength, and balance) it also improves mental health and well being and pain management. It is important to find the type of exercise that is the best fit given any physical or health limitations as well as personal preferences.

Diet. There are so many recommendations for what to eat and what to avoid, it is difficult to make sense of the information overload. What we put in our bodies does significantly affect how they function and how we feel. Gut health is extremely important for our immune system to function optimally. Good general rules to follow are trying to minimize highly processed foods and consume fat, salt, sugar, and alcohol in moderation. Paying attention to your body can also be helpful in eliminating foods your body has difficulty processing.

Nature. Spending time in nature has tremendous healing benefits. Depending on where you live and the time of year, it may be challenging to spend large amounts of time in nature. Look for ways to get fresh air, be near bodies of water, spend time in forests, and feel the wind against your skin.

Photo by Kathy Kroening. Quinault Rain Forest, WA. July, 2016

While being in nature has many physical and spiritual benefits it also provides many examples of resilience.  I am in love with old growth forests and the trees that live for centuries. They are thriving, not just surviving. What are their secrets that may help us emulate their success? To survive strong winds, they learn to bend but not break. They store up nutrients and moisture when plentiful and conserve when sparse. They find creative ways to photosynthesize when access to light is compromised. Root systems that are deep and wide help with anchoring and grounding and those that connect with other systems provide additional support. As a community of women, we can learn from these wise beings and utilize the same tools for building resilience. We can transcend survival and learn to thrive.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Kaminska, M., Schneider-Matyka, D., Rachubinska, K., Panczyk, M., Grochans, E., & Cybulska, A. (2023). Menopause Predisposes Women to Increased Risk of Cardiovascular Disease. Journal of Clinical Medicine, 12(22), 7058. https://pmc.ncbi.nlm.nih.gov/articles/PMC10672665/

Khoudary, S., Aggarwal, B., Beckie, T., Hodis, H., Johnson, A., Langer, R., Limacher, M., Manson, J., Stefanick, M., & Allison, M. (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement from the American Heart Association. Circulation, 142(25). https://www.ahajournals.org/doi/10.1161/CIR.0000000000000912

Knezevic, E., Nenic, K., Milanovic, V., & Knezevic, N. (2023). The Role of Cortisol in Chronic Stress, Neurodegenerative Diseases, and Psychological Disorders. Cells, 12(23), 2726. https://www.mdpi.com/2073-4409/12/23/2726

Makary, M., Nguyen, C., Hoeg, B., & Tidmarsh, G. (2025). Updated Labeling for Menopausal Hormone Therapy. Viewpoint: Women’s Health. Journal of the American Medical Association (JAMA). https://jamanetwork.com/journals/jama/fullarticle/2841321

Osborne, M., Shin, L., Mehta, N., Pitman, R., Fayad, Z., & Tawakoi, A. (2020). Disentangling the Links Between Psychosocial Stress and Cardiovascular Disease. Circulation: Cardiovascular Imaging, 13(8). https://doi.org/10.1161/CIRCIMAGING.120.010931

In late November, the Department of Education’s (ED) Reimagining and Improving Student Education (RISE) committee spent several weeks discussing regulations for the One Big Beautiful Bill Act (OBBBA) loan-related provisions. They proposed higher loan limits for students earning professional degrees including “Pharmacy (Pharm.D.), Dentistry (D.D.S. or D.M.D.), Veterinary Medicine (D.V.M.), Chiropractic (D.C. or D.C.M.), Clinical Psychology (Psy.D. or Ph.D.), Law (L.L.B. or J.D.), Medicine (M.D.), Optometry (O.D.), Osteopathic Medicine (D.O.), Podiatry (D.P.M., D.P., or Pod.D.), and Theology (M.Div., or M.H.L.).” (Desjean, 2025) Nursing (D.N.P. or Ph.D.) was not included in this list. (Desjean, 2025)

The voting RISE committee members include six men and four women. Seven of them are employed in research, policy, or leadership positions related to higher education, two are attorneys, and one is a project manager for UnitedHealthcare. (United States Department of Education, 2025) The RISE committee used the Higher Education Act of 1965 definition of professional degrees to determine which programs would qualify for higher student loan amounts. The wording of this definition describes 10 programs as examples but clearly states the definition of professional degree is not limited to these programs. (National Archives, 2025) This definition also states other programs that have the same Classification of Instructional Programs (CIP) code as the 10 examples could also be considered a professional degree program. (Desjean, 2025) The CIP codes were developed in 1980 by the National Center for Education Statistics (NCES) as a coding system for instructional programs. These were meant to be generic categories for statistical coding purposes and were never intended to be an official list of recognized or permitted programs. (National Center for Education Statistics, 2010) This information suggests a very arbitrary designation of professional degrees and an examination of the CIP codes adds confusion.  The codes are 01.80 for veterinary medicine, 22.01 for law, 39.06 for theological and ministerial studies, 42.28 for clinical, counseling, and applied psychology, and 51.01, 51.04, 51.12, 51.17, 51.20 respectively for chiropractic, dentistry, medicine, optometry, and pharmacy, pharmaceutical sciences, and administration. (National Center for Education Statistics, 2020) The first Doctor of Nursing Practice program was established in 2001 and three years later the American Association of Colleges of Nursing (AACN) endorsed moving the level of preparation for advanced practice from a master’s degree to a Doctor of Nursing Practice Degree. (American Association of Colleges of Nursing, 2025) While this degree was not yet established at the time of the Higher Education Act of 1965 or the development of the CIP codes in 1980, it is included in the subsequent revisions to the CIP codes. The broad CIP category for registered nursing, nursing administration, and clinical nursing is 51.38 and for the DNP specifically 51.3818. This code is very close to that of the other healthcare related disciplines and the program and licensing requirements are similar so the decision not to include nursing as a professional degree was either very arbitrary or very intentional.

Since this proposal was announced there has been tremendous public backlash, especially from the nursing profession. The Department of Education accused the outraged of creating fake news, distorting the truth, fear mongering, and spreading misinformation. (Laws, 2025 and Miller, 2025) They published a Myth vs. Fact sheet regarding the definition of professional degrees in response to the outrage. (U.S. Department of Education, 2025) This fact sheet targets nurses specifically. Are nurses upset? Absolutely. Do we have a chip on our shoulders? In reality it is more like a boulder. Is this an overreaction borne of hysteria? No. There is good reason for this response.

I have been licensed as a Registered Nurse (RN) in Washington State for 41 years and as an Advanced Registered Nurse Practitioner (ARNP) for 30 years. I have a Bachelor of Science in Nursing (BSN), a Master of Nursing (MN), and a Doctor of Philosophy (Ph.D.) in Nursing Science. In addition to my half-time clinical practice, as an adjunct faculty member I taught undergraduate nursing courses at the University of Washington for 18 years. I feel I am uniquely qualified to discuss this issue.

In order to understand the backlash surrounding the RISE committee’s recent proposal, you need to be familiar with the history of nursing in this country. For centuries, tending to the sick happened at home and was performed by family members and friends. Considered women’s work, most caregivers were (and still are) women. As the population increased, urban environments were created. At the beginning of the 19^th century, hospitals began to replace homes as the setting for care for the sick, especially those with serious illnesses or without resources. With few opportunities for formal training, the care nurses provided varied dramatically. The earliest attempts at nursing education in the US were programs or texts developed by physicians specifically focused on maternity patients and home care. (PennNursing, 2011)

The Civil War in the early 1860’s was a catalyst for the development of nursing training. Approximately 20,000 nurses served during the war and the experience of having many individuals specifically dedicated to healing the wounded sparked a number of attempts at formal training programs. Following in the footsteps of Florence Nightingale, who founded nurse education programs in several hospitals in Britain after leading a group of women to care for wounded British soldiers in the Crimea, in 1873 three schools of nursing based on the Nightingale Principles were developed in the US. The Boston Training School at Massachusetts Hospital, the Connecticut Training School at the State Hospital, and the New York Training School at Bellevue Hospital were the forerunners of formal nursing education. By the turn of the century there were approximately 600 nursing programs in the US. (PennNursing, 2011)

The early nursing programs were apprenticeships that took advantage of student nurses for labor. Although popular, they were exploitative. In the late 1890’s the first two professional organizations within nursing were created and were the forerunners of the National League of Nursing Education and the American Nurses Association. The beginning of the 20^th century saw significant progress in nursing’s professional development including: the first publication of the American Journal of Nursing in 1900; the formation of state nursing associations in New York, New Jersey, North Carolina and Virginia and creation of the Army Nurse Corps in 1901; passage of the first nurse registration act licensing professional nurses in North Carolina in 1903; creation of the Navy Nurse Corps in 1908; and the opening of the first university based school of nursing at the University of Minnesota in 1909. Nursing has always been a female dominated profession and these women have never shied away from the call to care for and heal the sick and wounded regardless of potential dangers. Approximately 23,000 American nurses served in World War I, over 70,000 in World War II (WWII), around 7,000 in the Korean War, and approximately 10,000 in the Vietnam War. (PennNursing, 2011)

After WWII debate began in the nursing community regarding educational preparation for nurses. Some felt the basic level of preparation should remain with two-year hospital-based programs or community college programs while others argued it should be a Bachelor of Science in Nursing (BSN) degree. By the 1960’s there were roughly 170 BSN college programs. Around that same time advanced practice roles were developing for both Clinical Nurse Specialists and Advanced Registered Nurse Practitioners in many specialty areas. Nursing research was also increasing with the aid of federal funding. (PennNursing, 2011) Today over 70% of the nursing workforce have a BSN or higher degree as their highest level of education. (American Association of Colleges of Nursing, 2024)

For years nurses worked long hours with low pay and little respect, despite being the health providers who spent the most time in direct patient care. Although nursing has been rated as the most honest and ethical profession for the last 23 years, nurses experience one of the highest number of assaults from patients. A recent survey found two nurses are assaulted every hour in the United States. (American Hospital Association, 2025; Walker, 2025) Nurses have worked long and hard to establish themselves as a respected profession and push for workplace protections, regulations, and pay that is commensurate with their education, experience, and job requirements.  While significant improvements have been made, it is a constant battle, especially at the advanced practice level. This is part of what makes the recent proposal from the Department of Education so invalidating.

When I was completing my master’s degree 35 years ago, I remember having a conversation with a new acquaintance.  They asked what field my degree was in and when I replied nursing, they appeared confused.  They asked what my bachelor’s degree was in and when I replied nursing, they seemed even more confused and stated, “I thought nurses were just, you know, nurses”. This made me experience irritation and anger but I realized it would be more helpful to educate them about the field of nursing, the educational and licensing requirements, and what nurses do. I thought over time this situation would rectify itself but within the last six months I had a physician ask me about my Ph.D., specifically what it involved, insinuating it was less rigorous than other Ph.D. programs. Again, my initial feelings were irritation and anger but I explained to the physician that it was the equivalent of other Doctor of Philosophy programs and I was required to conduct research and write a dissertation. This sparked interest on the part of the physician in hearing about my research. While I appreciated the expressed interest it was still frustrating after all these years to be judged as “less than” because I chose the profession of nursing.

Nurses are the backbone of healthcare. We are care coordinators working collaboratively with other members of the health care team to advocate for the needs of patients and families. We spend more time in direct care with patients and families than other members of the health care team. We work in hospitals, clinics, schools, homes, prisons, jails, institutions, corporations, and communities. At both the generalist (registered nurse) and advanced practice (nurse practitioner) levels we provide holistic, patient centered care. Without nurses our entire health care system would collapse.

Photo by Kathy Kroening. Air Force Nurse Corps Pin (Staff of Asclepius representing medicine and healing and the lamp representing knowledge). Seattle, WA

If you or a loved one is in the Intensive Care Unit (ICU) a nurse will be the first person to recognize subtle changes in condition and initiate contact with the team to address the issue. If your child has an injury, allergic reaction, asthma attack, seizure, or other medical emergency at school, a nurse will be the first medical point of contact to manage this event. During COVID nurses played a vital role in patient care. Many nurses found their unit turned into a COVID unit overnight and due to a shortage of personal protective equipment (PPE) many were exposed to the virus resulting in acute illness, long COVID, and death. Nurses were often asked to spend large amounts of time in a room with patients in isolation, covered from head to toe in PPE, and asked to perform not only nursing duties but those of other team members including certified nursing assistants, lab and phlebotomy, and housekeeping. A nurse was frequently the one holding the phone or tablet so loved ones who were not allowed to visit could say goodbye. A nurse was most often the person present when a patient took their last breath. This created tremendous stress and burnout and it is estimated that 100,000 nurses left the profession during the first two years of the pandemic. (National Council of State Boards of Nursing, 2023)

Contrary to long standing beliefs, nurses are not doctor’s assistants. A BSN degree is a rigorous academic and clinical program. While programs vary, applicants to the degree program at the University of Washington are required to complete approximately 80 quarter hour credits worth of prerequisite courses including written communication, math or philosophy of logic and basic statistic, lifespan growth and development and social sciences, arts and humanities, and natural sciences including general chemistry, organic chemistry, human anatomy and physiology, general microbiology, and nutrition. (University of Washington School of Nursing, 2024). After acceptance to the Nursing program they spend their final two years immersed in theory and clinical courses covering: health assessment; professional practice; pharmacotherapeutics; pathophysiology; health equity; introduction to research; healthcare systems; advanced clinical judgment; care coordination and case management; informatics, patient safety, and quality improvement; interprofessional practice involving case simulations with student from other health care disciplines like medicine and pharmacy; and theory and clinical courses in nursing care of ill adults and the specialty areas of community health nursing partnerships, psychosocial nursing, pediatric nursing, and care of childbearing families. In their final quarter, students complete transition to professional practice, a clinical intensive experience in a specialty area with an individual preceptor from the clinical workplace. (University of Washington School of Nursing, 2025) While registered nurses perform many tasks during the course of their day a good representation includes: patient examination and assessment; CPR, basic, and advanced life support when necessary; medication administration; IV placement and monitoring; wound care; catheterization; NG tube placement and feeding; infection control; and electronic medical record charting. These tasks require advanced skills in communication, team leading, critical thinking, organization, and time management. Nursing is an artful combination of science and technical skills informing care that is offered with empathy, compassion, and presence.

Advanced registered nurse practitioners (ARNP’s) provide services similar to those of physicians in many specialty areas including adult gerontology acute and primary care, anesthesia, family care, midwifery, pediatric acute and primary care, population health and leadership, psychiatric mental health, and women’s health.  Nurse practice acts vary by state so the level of practice also varies.  In my home state of Washington ARNP’s practice independently with no supervision from physicians or other health care professionals. Acceptance into a DNP program requires completion of a Bachelor of Science in Nursing degree or Master of Nursing degree and current licensure as a registered nurse in addition to specific academic, personal, and professional requirements. While programs vary by institution, a sample program covers leadership, appraisal and application of evidence to advanced practice, health equity, health systems and policy, wellness and health promotion, and quality improvement during the first year. The second and third year of the program focus on specialty specific content and clinical experiences working one-on-one with clinical preceptors in practice settings. Completion of a DNP project in collaboration with a community agency is also required. (University of Washington School of Nursing, n.d.) ARNP’s perform the same services as physicians including diagnosis and treatment, prescribing medications, performing procedures, and following patients in the hospital after surgical procedures or illness. They also deliver babies and provide anesthesia.

What effect would limiting student loans for graduate nursing degrees have on nursing and health care? While it may be difficult to answer this question specifically there are several things to consider. Average costs to complete a Bachelor of Science in Nursing degree can range from $90,000 to $211,000 depending on whether the program is at a public or private institution and whether a student is paying in state or out of state tuition.  Average costs for a master’s degree in nursing range from $28,000 to $79,000. Average costs for a Doctor of Nursing practice degree range from $111,000 to $172,000. (Robinson, 2025). The Department of Education proposed loan limits allow “professional degree” students to borrow $200,000 while all other degree programs are limited to $100,000.  You can do the math. Keep in mind that while a BSN degree would not qualify for these loan limits this is money already spent prior to entering an advanced degree program which impacts students’ financial resources. Will this deter people from entering nursing as a career?  It is difficult to predict but may certainly deter some nurses from pursuing advanced practice degrees. A more challenging question to answer is whether such public disrespect from the US government towards the profession of nursing will deter students from choosing it and instead gravitate towards other more respected professions.

Regardless of the cause of fewer individuals entering the nursing profession, loss of both registered nurses and advanced practice nurses would be devastating for a medical system that is already crumbling. By the year 2032 there is expected to be a shortage of approximately 328,000 registered nurses and close to 34,000 advanced registered nurse practitioners. This shortage is due to a combination of a large number of nurses nearing retirement age, nurses leaving the profession due to burnout, and insufficient nursing faculty to accommodate increased enrollment in nursing programs. (Twenter, 2025) This shortage is happening at the same time millions of baby boomers are reaching an age when their medical care needs will increase dramatically. Fewer nurses in hospital settings leads to increased patient infections, hospital stays, readmissions, and mortality. (American Association of Colleges of Nursing, 2024) Higher patient loads lead to stress and burnout in nurses increasing the number of those leaving the profession. Nurse practitioners are already playing a vital role filling the gaps in primary care, especially in rural communities. Projected shortages will increase wait times for appointments leading to decreased access to care for many, increased urgent care and emergency room visits, and increased morbidity and mortality.

Given the potential for significant negative consequences, will the Department of Education stand by their current proposal? The fact sheet they developed in response to the outrage about the exclusion of nursing tries to undo the damage by making several claims. The fact sheet states: 95% of nursing students borrow less than the annual loan limit so they won’t be affected by the new caps; placing caps on loan limits will actually decrease tuition; and the decision to exclude nurses was not a value judgment on the part of the Trump Administration. (U.S. Department of Education, 2025) There is no way to verify most of this information and it seems to have been a hasty response to justify a decision made without much thought. Currently, a bipartisan group of legislators are pressing the RISE committee to change their definition to include nursing. (Binkley, 2025) Even if the definition is changed the damage is already done. Nursing remains the profession with the highest number of women, approximately 89%. (American Association of Colleges of Nursing, 2024) The decision to exclude nursing as a professional degree appears to be yet another assault on women by the current administration, something I have detailed in prior blog posts including Women Are People Too. I hope as nurses we use our wisdom and power in numbers to inform the public about our education and training as well as the invaluable services we provide. If you want to make a nurses’ day, acknowledge their commitment to promoting and maintaining health and wellness and thank them for the care and compassion they provide.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

American Association of Colleges of Nursing. (2024). Fact Sheet: Nursing Shortage. https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/Nursing-Shortage-Factsheet.pdf

American Association of Colleges of Nursing. (2024). Nursing Workforce Fact Sheet. https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet

American Association of Colleges of Nursing. (2025). Fact Sheet: The Doctor of Nursing Practice (DNP). https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/DNP-Fact-Sheet.pdf

American Hospital Association. (2025). Fact Sheet: Workplace Violence and Intimidation, and the Need for a Federal Legislative Response. https://www.aha.org/fact-sheets/2023-04-19-fact-sheet-workplace-violence-and-intimidation-and-need-federal-legislative-response#:~:text=Data%20supports%20these%20news%20accounts,potential%20for%20adverse%20medical%20events

Binkley, C. (2025). Lawmakers Urge Education Department to add Nursing to “Professional” Programs List Amid Uproar. KCRA. https://www.kcra.com/article/lawmakers-urge-education-department-nursing-to-professional-programs/69704906

Desjean, J. (2025). You Have Questions; We Have Answers: Making Sense of the Student Loan Changes from OBBBA’s RISE Committee. National Association of Student Financial Aid Administrators (NASFAA). https://www.nasfaa.org/news-item/37700/You_Have_Questions_We_Have_Answers_Making_Sense_of_the_Student_Loan_Changes_from_OBBBA_s_RISE_Committee

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As we hit the one-year mark of the second presidential election featuring a woman candidate and a second Donald Trump presidency, the question of whether a woman can lead the United States demands answers. Despite two exquisitely qualified women candidates whose credentials and performance in public service outshined their opponent, neither was elected. A deeper dive into the 2016 presidential election is a good starting place to examine these confusing outcomes.

The United States has a poor track record when it comes to women in leadership roles. Only 10.4% of Fortune 500 companies had women CEOs in 2024. (Women Business Collaborative, 2024) The current United States Congress is made up of 26% women in the Senate and 29% women in the House of Representatives. (Center for American Women and Politics (CAWP), 2025) Twenty six percent of governors in the U.S. are women. (Navarre & Kronenberg, 2025) In US cities with a population over 30,000 residents, 26.8% of mayors were women in 2024. (CAWP, 2024) Only one woman has ever been elected vice president of the United States and we have yet to elect a woman president. Among United Nations countries, 78 have had women serving as head of state or government. (Warnes, 2024) In fact, many of these female leaders have had long tenures: Sheikh Hasina, Bangladesh, 20 years (two separate terms); Indira Gandhi, India, 15 years (two separate terms); Angela Merkel, Germany, 16 years; Vigdis Finnbogadottir, Iceland, 16 years; Eugenia Charles, Dominica, 15 years; Mary McAleese, Ireland, 14 years; Ellen Johnson Sirleaf, Liberia, 12 years; Tarja Halonen, Finland, 12 years; Margaret Thatcher, United Kingdom, 11 years; and Chandrika Kumaratunga, Sri Lanka, 11 years.  Why do women continue to be under-represented in leadership positions in this country despite no evidence to suggest they lack the intellect, skills, or motivation to excel and succeed? It is a difficult question to answer, with multiple layers of sociocultural and political factors to evaluate.

Qualifications

A good place to start examining the 2016 election is with the candidates’ qualifications to lead this country. Hillary Clinton graduated with a bachelor’s degree in political science from Wellesley College then earned a law degree from Yale. She spent 12 years as the First Lady of Arkansas, advocating for children and families, and practicing law. In 1984 she was named Arkansas Woman of the Year. She became First Lady of the United States in 1993 and focused on health care reform while continuing her support for children and families. (National Archives, n.d.) She traveled to over 80 countries, advocating for civil society, democracy, and human rights. She served as a senator for New York from 2000-2008 and was the first woman elected to state office in New York.

Senator Clinton was the first woman to win a presidential primary in 2007. She served as Secretary of State for four years under President Barack Obama. She visited 112 countries, was instrumental in the groundwork for restraining Iran’s nuclear program and negotiating a ceasefire deal in the Middle East. In 2016 she became the first US woman nominated for President by a major political party. (The Office of Hillary Rodham Clinton, n.d.) Hillary Clinton’s net worth at the time of the election was estimated at $32 million, most from speaking engagements and book royalties. (Karni & Taft, 2015)

Donald Trump attended the New York Military Academy in high school then earned a Bachelor of Science degree in Economics from Wharton School of Finance and Commerce at the University of Pennsylvania. He became a real estate developer, businessman, author, and reality television personality starring in The Apprentice. (National Archives, n.d.) At the time of the election Trump’s net worth was estimated at $3.7 billion. (Cillizza, 2020) During the campaign, Trump and his opponents discussed his company bankruptcies. Early on Hillary Clinton declared he had four and Trump himself seemed confused stating different numbers during different debates, claiming that among hundreds of business deals his companies filed for bankruptcy three or four times. The actual number was six. Trump claimed these filings were a legitimate business strategy that helped him add to his personal wealth. It has been suggested that although this is common in the corporate world, Trump had many bond holders who were individuals that invested their retirement savings in these corporations and lost it all. (Winter, 2016)

In a Washington Post article published in the summer of 2016, claims were made that Donald Trump’s first public company, Trump Hotels and Casino Resorts, lost money every year under his leadership. (Harwell, 2016)   Trump served as chairman from 1995 to 2009 and chief executive from 2000 to 2005. During his tenure in charge: the company lost approximately $1 billion dollars; stock prices dropped from $35 dollars a share to a low of 17 cents; he received a $5 million dollar bonus in a year the stock dropped 70 percent; he made approximately $44 million dollars in salary plus millions more in perks and special deals; and stockholders, including employees, lost millions. This information about his business leadership skills was known prior to the election.

Allegations, Lawsuits, and Scandals

As long-time politicians Bill and Hillary Clinton were no strangers to scandal prior to the 2016 election. Many of these improprieties were detailed in a National Public Radio (NPR) article published in the summer of 2016. (Johnson, 2016) In 1992 the Clintons contributed financially to the Whitewater Development Corporation. Although a justice department investigation did not lead to prosecution of the Clintons, their partners were convicted of fraud. In the first year of Bill Clinton’s presidency, seven workers from the travel office were fired. This was alleged to be the result of purging to make room for those loyal to the Clintons. There were multiple investigations with no charges ever filed. That same year Vince Foster, a White House lawyer, was found dead in a Virginia park. Some suggested he was murdered for his role in ethics investigations against the Clintons although family members and investigators stated he struggled with depression. Multiple investigations concluded he died by suicide. In 1994 Bill Clinton was accused of having sexual relationships with several women including Monica Lewinsky. He settled one lawsuit brought by Paula Jones and after initially denying the relationship with Lewinsky made a public apology for having an inappropriate relationship with her. The House of Representatives voted to impeach him. In 1999 the Senate acquitted him of obstruction of justice and perjury related to these offenses. In 1996 accusations were made against the Clintons related to the discovery of hundreds of FBI files on former White House workers including Republicans in Congress. An investigation was unable to link the Clintons to these files.

In 2012 four Americans were killed by extremists at the US diplomatic compound in Benghazi, Libya. Hillary Clinton was accused by members of Congress of failing to protect Americans and lack of accurate information about the attack. (Johnson, 2016) In 2015 some Republicans and watchdog groups alleged The Clinton Foundation had conflicts of interest during her tenure as Secretary of State. Investigations were ongoing at the time of the election. That same year the FBI and the Justice Department began investigating Clinton’s use of a private email server that may have comprised the security of classified government information.  The investigations were ongoing during the election.

What other information was known about Donald Trump prior to the November 2016 election? An NBC news article published in October 2016 detailed numerous allegations of sexual assault and sexual harassment against Trump. (Carmon, 2016) The allegations included four reports of unwanted kissing, 5 reports of groping, 7 reports of sexual assault, multiple reports from the Miss Teen USA pageant, which he owned at the time, of Trump walking in on contestants while they were dressing, and reports of a hostile work environment on The Apprentice due to Trump’s lewd comments about women.  Trump and his representatives vehemently denied all claims even though there were two audio recordings circulating at that time of Trump bragging about these behaviors. The first was from an Access Hollywood interview in 2005 where Trump stated “I just start kissing them. It’s like a magnet. Just kiss. I don’t even wait,” and “as a star you can do anything,” including “grab them by the pussy.” The second was from an interview with Howard Stern, also from 2005 in which he told the radio host: “I’ll tell you the funniest is that I’ll go backstage before a show and everyone’s getting dressed,” Trump told Stern. “No men are anywhere, and I’m allowed to go in, because I’m the owner of the pageant and therefore I’m inspecting it. … ‘Is everyone OK’? You know, they’re standing there with no clothes. ‘Is everybody OK?’ And you see these incredible looking women, and so I sort of get away with things like that.”

While all of these behaviors were unwanted, inappropriate, and fit the definition of sexual harassment at a minimum, several allegations were made during court filings that were more violent. During divorce proceedings from his first wife Ivana in 1990, she made a statement during a deposition that her husband had raped her in 1989. When the story was revived in the media in 2015, Trump attorney Michael Cohen minimized the claim by stating she was talking about an emotional feeling rather than a physical act and “Understand that by the very definition, you can’t rape your spouse.” This statement was in fact untrue since rape of a spouse was illegal in New York at the time of the alleged event. After being asked by Trump to comply with a confidentiality clause surrounding their divorce and an affidavit in September 2016 seeking to keep the divorce records sealed, Ivana Trump recanted her allegation. (Carmon, 2016) The most disturbing claim was that Trump raped a 13-year-old girl in 1994. This case was pending in federal court at the time of the 2016 election. The woman alleged bondage, violent rape, hitting, screaming, and threatening to harm or kill her and her family if she ever discussed the event. This allegedly took place at the home of Jeffrey Epstein and the complaint included an affidavit from a witness. (Carmon, 2016)

In October of 2016 Trump attorney Michael Cohen made a $130,000 dollar payment to adult film actor Stormy Daniels to persuade her to keep quiet about an alleged affair with Trump in 2006. Although it took eight years, in May of 2024 Trump was found guilty on all 34 counts of falsified business records related to this payment but due to his re-election as President he was sentenced to an unconditional discharge with no consequences. (Katersky & Charalambous, 2025) According to multiple sources there were many other active lawsuits against Trump’s companies during the 2016 election however they are too numerous for elaboration here.

Campaign Finance

Hillary Clinton raised more than $1.2 billion during her campaign compared to Trump’s $600 million. Trump contributed a little over $66 million to his campaign from his own personal wealth. (Beckel & Levinthal, 2016) He also used his own assets and infrastructure to his advantage, flying in his own private jet, and hosting campaign events at his resorts. He received a significant amount of free airtime which dramatically cut campaign expenses.  Clinton spent a large amount of money on television ads and her get-out-the-vote campaign however Trump was very strategic in his spending, targeting groups of Clinton backers on social media, using negative ads to decrease Democratic voter turnout in battleground states. (Allison et el., 2016)

Campaign Advertising

In revisiting a sample of five popular political television ads for both candidates from the 2016 election, several themes dominated. Donald Trump focused heavily on immigration recommending a temporary ban on Muslims entering the United States, building a wall along the southern border that he would force Mexico to pay for, preventing Syrian refugees from entering the country, and bombing ISIS. He touted himself as the new leader poised to deliver America from broken politics by lowering taxes, providing childcare tax credits, and restoring law and order balanced with justice and fairness. One of his ads focused exclusively on comments made by Secretary Clinton that many of his supporters were deplorable. It is noteworthy that the National Rifle Association (NRA) spent $30 million on thousands of ads in support of Dondald Trump. (Beckel & Levinthal, 2016)

Hillary Clinton focused on measuring the success of America by what we do for our children and the values we pass on. She advocated for good schools, college education without debt, jobs that provide a living wage, working together, and respecting one another. Three of her top ads targeted Donald Trump’s language and the message it sent to children, girls, and Muslim Americans. Clinton’s ad “Daisy” featured the girl from the first “Daisy” political ad for Lyndon B. Johnson in 1964, circling back to concerns about the use of nuclear weapons and Trump’s references to using bombs. You can find links to these 10 ads in the reference section below.

The Debates

A fresh review of all three 2016 presidential debates between Hillary Clinton and Donald Trump highlighted strengths and weaknesses of the two candidates and their political strategies. It is helpful to keep in mind that true debate is very formal and structured with equal time given to participants and a requirement for providing evidence to support claims. It is also a civilized event where value is placed on the strength of a logical argument devoid of strong emotion and inflammatory language. There was certainly mudslinging from both sides and attempts by Donald Trump to gaslight Secretary Clinton. For the most part she did not respond but by the third debate tensions escalated with a decline in civility from both candidates.

Secretary Clinton’s debate strategy appeared to be straightforward. She answered moderator and audience member questions directly and provided specific strategies in her plan for addressing the economy, foreign policy, health care, and immigration. Donald Trump’s strategy appeared to be attack and evade. He placed blame on Secretary Clinton, President Obama, former President Bill Clinton, and others for multiple issues and did not answer specific questions even after being asked multiple times by moderators.  He was scant on details about his plans for the economy, foreign policy, health care, and even immigration which was one of his primary areas of focus.

Secretary Clinton did a better job of using neutral language and focusing on potential repercussions of decisions made rather than resorting to character assassination. Donald Trump repeatedly talked over both Secretary Clinton and the moderators even with multiple requests to be quiet and allow Secretary Clinton to finish her allotted time. Much of his language was phrased as personal attacks and again he was scant on details of his plan and how it was superior to his opponent’s. The third debate was much more contentious and in the last five minutes Donal Trump made the statement “Such a nasty woman” while Secretary Clinton was speaking. She did not respond to this statement. In all three debates the audience members were asked to remain silent. In the third debate in particular, there was significant verbal audience approval of Donal Trump’s derogatory remarks to and about Secretary Clinton. You can find links to all three debates in the reference section below.

The Vote and Voter Demographics

 In the 2016 presidential election, Hillary Clinton received 65,853,514 votes which was 48.18% of all votes. She won the popular vote over Donald Trump by a margin of 2.09% which amounted to almost 2.9 million votes. This made her the losing presidential candidate with the highest margin of the popular vote over her opponent in United States history. (Lerer, 2016) Why was she not the first woman president of the United States? She lost the Electoral College vote 304 to 227. (Federal Election Commission, 2017) The Electoral College was created by our Founding Fathers as part of the Constitution. It was an attempt at a compromise between Congress and the people electing the US president. (National Archives, n.d.) Each state has the same number of electors as it has in its congressional delegation. The District of Columbia is also given three electors. How exactly does this process work?

Each presidential candidate has their own slate of electors attached to them in each state. While the procedure for choosing electors varies by state, most are selected at their political party convention. They are either nominated or chosen by the central committee and are often selected as recognition for their loyalty and service to the party. A vote for a presidential candidate is generally also a vote for their slate of electors and most states have a winner take all policy, with the exception of Nebraska and Maine possibly leading to a split vote in those states. Historically, 99% of the time electors have voted as pledged, for the candidate of their party. (National Archives, n.d.)

There have only been four other elected presidents in U.S. history who did not win the popular vote. In 1824 John Quincy Adams lost the popular vote by 10.5% and interestingly also lost the Electoral College vote to Andrew Jackson by 5.7%. Since neither candidate received a majority of the electoral votes, Adams was elected by the House of Representatives amid claims of deal brokering and corruption. (United States House of Representatives, n.d.) Other candidates who won the election but lost the popular vote were Rutherford B. Hayes in 1876, Benjamin Harrison in 1888, and George W. Bush in 2000. (Woolley & Peters, 2024).

An examination of votes by gender, age, ethnicity, and education provides additional information that may help answer questions about the election results. Keep in mind there were four primary candidates for the 2016 election and five additional candidates received electoral college votes. Votes for Clinton were higher in all women (54%), 18-29 year olds (58%), 30-49 year olds (51%), those who identified as Black (91%) and Hispanic (66%), Black men (81%) and women (98%), Hispanic men (65%) and women (67%), all college graduates (57%), white college graduates (55%), non-white college graduates (68%) and non-white non-college graduates (77%). (Pew Research Center, 2018) The votes for Trump were higher in men (52%), 50–64-year-olds (51%), those over 65 (53%), those who identified as White (54%), white men (62%), white women (47%), all non-college graduates (50%), and White non-college graduates (64%). Trump had a slight edge in voters who identified as Independents (43% to Clinton’s 42%).

Analysis

Hillary Clinton clearly had the advantage in credentials to serve as President of the United States. Donald Trump and many of his supporters claimed her experience was a drawback because career politicians were hesitant to go against party lines. While this may be true, having experience with the system one has to work in and learning how to negotiate and compromise are critical skills for the highest position in our country. As a businessman, this was not something Trump had experience with and he was used to making unilateral decisions despite consequences for others. He is in fact the only elected US President with no political or military experience. (Crockett, 2017)

Hillary Clinton also held the advantage in campaign funding. Her campaign ads were professionally done, provided more information about her goals, and outnumbered those coming from the Trump campaign however he received a significant boost in ads from the NRA. The advantage in the debates also goes to Clinton in terms of professional behavior, answering questions accurately, and providing specific information about her plan for addressing the economy, foreign policy, health care, and immigration. In addition to these advantages, Hillary Clinton won the popular vote so why was she not the first woman President of the United States? The simplest answer is that the electoral college is problematic. It allows for a small number of states to have a significant impact on the election. So why not just eliminate it? That is easier said than done. It has been a bone of contention since its constitutional mandate, with approximately 700 failed proposals in Congress to either reform or eliminate it. (American Bar Association, 2019) Since it is part of the constitution it would require an amendment to change it which would take ratification by 38 states. The electoral college was definitely a factor in this election. However, it does not factor into most elections and was not a source of discrepancy in the 2024 election, test case #2 for a presidential election with a woman candidate. There were more complex issues that affected both elections that are worth discussing.

One of the key issues that arose multiple times while researching this piece was media control of the flow of information and access to facts. In 2016 approximately 88% of US adults used the internet. (Pew Research Center, 2025) That same year it was estimated that 68% of adults used Facebook, 28% used Instagram, 21% used Twitter, and 25% used LinkedIn. (Greenwood et al., 2016) Given these statistics it is probably fair to say that many voters were getting their information online during the 2016 campaign. With the staggering amount of misinformation available through the results of search engines and on social media platforms, how does the general public distinguish fact from fiction and important from irrelevant? We have not done a good job of teaching critical thinking skills in this country and that, combined with lack of time and information overload, has created a vortex of irreconcilable sound bites. Even if a person wanted to check facts, where do they go and how do they know the information they are accessing is accurate? The rapid rise of Artificial Intelligence (AI) will make this problem much worse. Are voters making decisions based on false information?

During the 2016 campaign critical information was both released and withheld from the general public in the final 12 days prior to the election. On October 28, 2016, James Comey, the FBI Director, informed Congress that the FBI had discovered new information that may or may not be relevant to Secretary Clinton’s use of a private email server that may have compromised classified government information. That day Republican Jason Chaffetz tweeted “FBI Dir just informed me, “The FBI has learned of the existence of emails that appear to be pertinent to the investigation.” Case reopened.” Three days later The New York Times, The Washington Post, The Las Angeles Times, NBC, ABC, and CBS all featured this as a top story. Donald Trump then used this information as a primary focus of his campaign activities until the election. Just two days before the election another letter from the FBI Director was sent to Congress and tweeted by the same individual stating the recent “new information” did not change the conclusion of the investigation. Ultimately, Clinton’s decision to use a private server was deemed careless but the investigation determined no classified information was compromised. Trump again used this information to his advantage by stating the system was rigged and Clinton was a criminal who should not be elected. (Murray, 2017) Some analysts believe the timing and manner in which this information was released, swayed undecided voters in key swing states that was enough to cost Clinton the electoral votes needed to win the election. What was not released by the FBI until after the election was their lengthy investigation of the Trump campaign’s possible ties to Russian interference with the election. At a Senate hearing in May 2017 the FBI director was questioned about why he released the information about the “new information” despite guidelines from the Justice Department prohibiting interference in elections. He was fired within a week of his testimony. In the final week prior to the election Trump also made numerous references to information on WikiLeaks critical of Clinton and encouraged voters to visit the site whose credibility was questionable.

The events that happened during this 12-day period raise additional questions about information flow, media regulation, and journalistic integrity. What drives decisions made by the owners, publishers, and editors in chief of the major newspapers and networks? Does journalistic integrity still exist in the United States? Who ultimately controls the flow of information to congress from the FBI and other government agencies, including the Department of Justice? Are members of Congress held to the same standard regarding sharing information that may affect the outcome of an election? In this election, the timing and accuracy of information appeared to play a crucial role in the outcome. If members of the general public cast their votes based on inaccurate information were the results of the election really valid? Honestly, delving deeply does not provide answers, it only creates more questions. What can the average voter do? Consult multiple sources to get information about candidates and issues including sources that are in opposition to your point of view.  Discuss candidates and issues with others, including those who may have differing views and really listen to what they are saying. Take time to analyze all the information you gather before making your decision.

Finally, what do the voter demographics tell us? Trump’s base of voter support was primarily white men and women over the age of 50 without a college degree. In some ways this is not a surprise. Depending on the source, between 47% and 53% of white women voted for Trump, which is disconcerting. I am not insinuating that more women should have voted for Hillary Clinton because she was the first women candidate for president. I am stating it is confusing that so many women voted for a man who openly made derogatory comments about women, mocked people with disabilities, and was disrespectful towards others because of their race, ethnicity, and religious beliefs. Even if you assumed the numerous claims made against Trump by women were false, his own public behavior spoke volumes about his beliefs. It was disturbing that the debate audience seemed to enjoy Trump’s derogatory comments towards Secretary Clinton. It reminded me of the school yard bully. People support the bully and join in the intimidation of others in order to avoid being the one bullied. Yes, standing up to the bully by yourself puts you at risk of physical harm and humiliation but it also shows others what is possible. When others begin to join you, it takes the bully’s power away, especially if you get the support of the school administration. This unmasks the bully and reveals a scared and powerless little boy who uses humiliation, threats, and violence to get attention and make him feel powerful. While it is up to each voter to decide what characteristics and actions are positive or negative in candidates it is interesting that using a personal email server appeared to be seen as more heinous than multiple claims of sexual harassment and sexual assault, including against minors. What does this say about our societal beliefs regarding women? I have written more extensively about this issue in my prior pieces A Man’s World (https://womenwomenspowerwomensrights.com/2025/09/16/a-mans-world/), Power and Control (https://womenwomenspowerwomensrights.com/2025/09/29/power-and-control/), and Going Backward (https://womenwomenspowerwomensrights.com/2025/10/14/going-backward/).

Photo by Kathy Kroening. Copalis, WA. March 2012

Circling back to my original question, can a woman lead the United States? The answer is yes. Hillary Clinton not only possessed a skill set unequaled by many former presidents, but she also won the popular vote. There is no doubt she was highly qualified and extremely capable of leading this country. A more meaningful question in search of answers is what needs to change to allow a woman to be elected President of the United States? In American society, the mirror for women is rigged. The reflection is not accurate. It distorts the essence of each individual woman, alters her ability to see herself whole and complete, and limits her potential. With whatever time I have left on this planet, I will work diligently towards creating a mirror for women that provides a true reflection, revealing their glorious beauty, strength, and power and showing them the sky’s the limit.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Allison, B., Rojanasakul, M., Harris, B., & Sam, C. (2016). Tracking the 2016 Presidential Money Race. Bloomberg. https://www.bloomberg.com/politics/graphics/2016-presidential-campaign-fundraising/

American Bar Association. (2019). ABA Legal Fact Check: Can the Electoral College be Abolished? https://www.americanbar.org/news/abanews/publications/youraba/2019/october-2019/q–the-electoral-college–is-it-open-for-interpretation-by-the-c/

Beckel, M. & Levinthal, D. (2016). By The Numbers: Election 2013. The Center for Public Integrity. https://publicintegrity.org/politics/by-the-numbers-election-2016/

Campaign Ad Video links Donald Trump
Make America Great Again: https://www.youtube.com/watch?v=OvL2LRz3CW4
Deplorables: https://www.youtube.com/watch?v=NbGZ6ZJYBkk
Movement: https://www.youtube.com/watch?v=hOH3z-9b0Zo
Dangerous: https://www.youtube.com/watch?v=eRjaHrh3IiU
Two Americas: https://www.youtube.com/watch?v=K32w98bAFKw

Campaign Ad Video links Hillary Clinton
Role Models: https://youtu.be/mrX3Ql31URA
Mirrors: https://youtu.be/vHGPbl-werw
Measure: https://youtu.be/e4y27luhDnM
Captain Khan: https://youtu.be/WCqFCCgU1xk
Daisy: https://www.youtube.com/watch?v=iSLtZynJg08

Carmon, I. (2016). The Allegations Womne Have Made Against Donald Trump. NBC News. https://www.nbcnews.com/politics/2016-election/allegations-women-have-made-against-donald-trump-n665731

Center for American Women and Politics. (2024) Women Mayors in U.S. Cities in 2024. Rutgers-New Brunswick, Eagleston Institute of Politics. https://cawp.rutgers.edu/facts/levels-office/local/women-mayors-us-cities-2024

Center for American Women and Politics. (2025) Women Serving in the 119^th Congress. Rutgers-New Brunswick, Eagleston Institute of Politics. https://cawp.rutgers.edu/facts/levels-office/congress/women-serving-119th-congress-2025-2027

Cillizza, C. (2020) Donald Trump is a Lot Less Rich Today Than When He Was Elected President. ThePoint. CNN. https://www.cnn.com/2020/09/09/politics/forbes-400-donald-trump-wealth

Crockett, Z. (2017). Donald Trump is the Only US President Ever with No Political or Military Experience. Vox. https://www.vox.com/policy-and-politics/2016/11/11/13587532/donald-trump-no-experience

Federal Election Commission. (2017). Federal Elections 2016: Election Results for the U.S. President, the U.S. Senate, and the U.S. House of Representatives. https://www.fec.gov/resources/cms-content/documents/federalelections2016.pdf

Greenwood, S., Perrin, A., & Duggan, M. (2016) Social Media Update2016: Facebook Usage and Engagement is on the Rise, While Adoption of Other Platforms Holds Steady. Pew Research Center. https://www.pewresearch.org/internet/2016/11/11/social-media-update-2016/

Harwell, D. (2016) As its Stock Collapsed, Trump’s Firm Gave Him Huge Bonuses and Paid for His Jet. The Washington Post. https://www.washingtonpost.com/business/economy/as-its-stock-collapsed-trumps-firm-gave-him-huge-bonuses-and-paid-for-his-jet/2016/06/12/58458918-2766-11e6-b989-4e5479715b54_story.html

Johnson, C. (2016) Clinton Scandals: A Guide From Whitewater to the Clinton Foundation. NPR. https://www.npr.org/2016/06/12/481718785/clinton-scandals-a-guide-from-whitewater-to-the-clinton-foundation#:~:text=Benghazi%2C%202012,and%20motivation%20for%20the%20attack

Karni, A. & Taft, I. (2015) Fear of Debt Drove Clinton’s Dash for Cash. Politico. https://www.politico.com/story/2015/09/hillary-clinton-candidate-wealth-2016-213317

Katersky, A. & Charalambous, P. (2025) Timeline: Manhattan DA’s Stormy Daniels Hush Money Case Against Donald Trump. ABC News. https://abcnews.go.com/Politics/timeline-manhattan-district-attorney-case-donald-trump/story?id=98389444#:~:text=OffOn-,Timeline:%20Manhattan%20DA’s%20Stormy%20Daniels%20hush%20money%20case%20against%20Donald,business%20records%20in%20New%20York.&text=Donald%20Trump%20was%20found%20guilty,2024%2C%20in%20New%20York%20City.&text=Here%20is%20a%20timeline%20of,candidate%20for%20president%20in%202015

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2016 Presidential Debate Video Links
Debate #1: https://www.youtube.com/watch?v=LxhhOfe3uWc
Debate #2: https://www.youtube.com/watch?v=7fmzBwnmQJM
Debate # 3: https://www.youtube.com/watch?v=0s4HTZUI2QU

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The relationship between mothers and daughters is complex.  As a psychiatric nurse practitioner, I have studied it extensively.  The last 20+ years of my career I have worked with teens and parents, witnessing numerous mother-daughter dyads in various stages of relationship.  As a daughter I have lived it. Mothers have a significant impact on their children’s lives but for daughters they embody what it means to be a woman.  They influence daughters’ self-esteem, confidence, social culture, body image, and expression of femininity. These relationships run the gamut from best friends to total estrangement with most being somewhere in the middle.  Intense love and extreme frustration can co-exist. Since family relationships are created through biological and genetic ties rather than personal choice, some parents and children are not always a good fit for each other. Every individual navigates their own journey within the family structure as they grow, age, and mature, making choices about identification, time, commitment, and support along the way.

“I am not your mother”, something no child ever wants to hear regardless of their age but something my mother has said to me several times within the past year. My mother is 91 years old and has advanced dementia. As her cognitive and emotional capabilities continue to decline I find myself frequently reflecting on our relationship and trying to make sense of what is happening to her. Since I started this blog in July my mother’s story has been filling my head and begging for release but I have resisted. Why?  A lot of what ifs.  What if I am unable to do her justice? What if it causes embarrassment for her or other members of my family? What if it is not good enough? What if I am not emotionally strong enough to write it? I can come up with many legitimate excuses but quite honestly the real reason is fear. There is a lot of water behind that dam and if I write, the dam will break, and I will drown. As much as I disdain my own tears, I cannot contain them. My intention is not to cause embarrassment or shame, which is really what keeps dementia a secret within families. My goal is to shine light on the debilitating consequences of dementia and bring awareness to a disease that devastates individuals and their families and will become a medical crisis in the next twenty years.

From the beginning it was pretty clear that my mother and I had very different personalities. I am much more like my father, fiercely independent, driven, hardheaded, stubborn and needing to be in motion.  My approach to life is very logical and analytical.  While I excel in providing emotional support to others in my work and my personal life, I am not adept at receiving. The strongest bond between my mother and I has always been our love of music.  She began playing the piano at the age of five and was both an accomplished pianist and vocalist as a young woman.  She would have loved a career in musical theatre but it was discouraged by her parents as an inappropriate career choice for a young woman at that time.  She enrolled me in piano lessons beginning at age five for which I am eternally grateful.  Music is one of my passions and something I enjoy on a daily basis.  I can’t imagine my life without it. Whether I am listening or playing music feeds my soul like nothing else.

Undated photo from Kroening family collection.

My parents met in college. My mother taught elementary school for a year while my dad finished his degree. My father trained as a pilot in the Air Force after he graduated and spent ten years in the military from 1956-1966. He flew tankers on refueling missions including B52 bombers. My brother was born in Texas and two years later I was born in Delaware.  My dad was away on missions for three weeks a month leaving my mom to single-parent two small children living far away from home. There were a number of crises in the United States and the world during that time including the Suez Canal crisis, the Bay of Pigs invasion, the Cuban Missile crisis, the assassination of John F. Kennedy, and the Vietnam War.  It was a scary time for everyone, but it created an immense fear for military wives and families who did not know when a crisis would become personal.

Given my father’s absences and a world that was very unpredictable, my mother’s resources were definitely limited.  While not intentional, I think I probably overwhelmed her patience and parenting resources as a young child.  During the time my parents were in the military, my mother wrote to her parents regularly and my grandmother saved a number of these letters which I inherited when she passed away. They are very enlightening.  In some ways it was reassuring to discover that the traits I like most in myself were present from a young age. But in other ways it was difficult to see how much my mom struggled during that time.

A few gems from those letters help illustrate the early battles my mother and I had. From 1963 when I was a year and 8 months: “What an independent cuss that Kathy is.  She wants you to do absolutely nothing for her!! I can’t even feed her – what she can’t get in her mouth by herself just doesn’t go in.  And she persists in doing things she isn’t supposed to do…last night she somehow got up high enough by the TV to work all the knobs and we couldn’t even get a picture.  Thought it had blown a tube already and we were cussing the TV – instead of Kathy, for a change. She can be the most loveable child and I try to cuddle her – which she does not like – as much as possible. But she can nearly drive me out of my mind as well.” From later that year when I was two years and five months: “Gosh she’s mature in her speaking – it doesn’t seem possible it’s all coming from a two-year-old. Jerry said she’ll be the terror of the neighborhood and will take on all comers.  She already fights for what is hers!!”

Perhaps my personal favorite was written several weeks after that: “…and when we were at Carsons Sandy took out a cigarette and Kathy was really taking it all in.  So Sandy said “Would you like to take out a cigarette for me?” and Kathy nodded.  So Sandy put back the one she had and allowed Kathy to get a cigarette for her. But Kathy wouldn’t give it up then so Jerry, over my protests said, “OK, light it and let her take a puff. We’ll teach her a lesson!” Kathy took a big breath, inhaled a small amount of smoke and as professional like as you please, blew the smoke out her nose.  No cough, no nothing! So Jerry tried again – the very same results! I don’t know who learned a lesson – but it wasn’t Kathy!! She didn’t even cough or even clear her throat!!”

While it may seem like my mother was being unfair in her assessment of me, I think she was confused and struggling to figure me out. In another letter written some time in the summer of 1964 when I was three, she wrote: “Kathy, the little pill, is cute as she can be at times.  I get so tickled at her.  She’s a talker and when I sit down and really talk to her, we can carry on quite a conversation.  But she’s so different in many ways from me that I struggle to understand.”  And that has really been the crux of our relationship.  We are very different and while we do share some interests and beliefs our timing was never great and we were often just out of sync. Have I loved my mother and has she loved me, absolutely, but love is complicated. I did not need her the way she needed and she could not parent me the way I needed.

Photo by Jerry Kroening. Dover, DE. 1963

When my father left the military in 1966, he purchased a Western Auto Store in a small town in Eastern Washington State. My parents had both grown up in small towns in Washington and wanted to raise their family in a similar environment.  My mother helped my dad with the store and was at home with my brother and I after school until I was in third grade.  At that time, in order to keep her teaching certificate active, she had to return to teaching and return to college for a “fifth year”.  She taught third grade in a classroom next to mine that year and attended night and weekend classes at the nearest college, about a 60-minute drive away. I remember seeing her doing homework in the evening and thinking how cool it was that my mom was in school now too!  It would take years before I realized the determination and stamina it took for her to do that.  She was helping her husband run a business, parenting an 8- and 10-year-old, teaching full-time, going to college nights and weekends, AND doing all the shopping, cooking, cleaning, laundry, and other household chores! As an adult it gave me a new perspective and a tremendous amount of respect for her persistence. She stopped teaching when I was in sixth grade and returned at the end of my senior year of high school, teaching elementary school until she retired.

Photo by Jerry Kroening. O’ahu, HI. 1969 

My mother was a stunningly beautiful, petite, fashionable, ultrafeminine, and elegant woman. I knew early on I was never going to be any of those things. As a kid I was a tomboy and puberty was especially brutal for me.  As a young teen, I was a tall, skinny, geeky girl with bad cystic acne and crooked teeth. Beginning in junior high, I channeled my energy into school and sports which kept me busy.  I appreciated my parents’ support at all of my sporting events. Once I went to college, I was pretty independent, working summers away from home so I did not spend much time there after high school. After college I spent the first five years of my career as an Air Force nurse and was far away from home for that time.  After leaving the military I settled in western Washington State, about 330 miles away from my parents. I think the time and distance helped me start to escape the shadow of my mother but I have to admit I was a very late bloomer when it came to embracing and expressing my own femininity.

Photo by Jerry Kroening. Lavenham, England. 1988

My parents enjoyed splitting time between a home in Arizona and their home in eastern WA in retirement. My mother started to display some memory problems in her late 70’s.  The first thing I noticed was her retelling a story in the same conversation without remembering she had done so.  It did not happen that often and my family attributed it to normal age-related changes.  In the fall of 2015, my father experienced complications from shoulder surgery and was hospitalized with an infection in the surgical site, pneumonia, and a separate infection in one knee. I cancelled a week of work and drove five hours to get to the hospital.  Although it was late I was allowed to see him, and he was not in good shape.  I honestly did not think he would survive the night (nor did he) and pretty much said my goodbyes.  I then drove an additional hour and half to my parent’s home to stay with mom who was not used to being alone. As expected, she was also not doing well.  My dad was in the hospital for a week and on IV antibiotics for another six weeks after discharge but recovered although he had limited use of the shoulder after that.

Undated Photo from Kroening Family Collection

During the five days I was there, my mom’s cognitive functioning declined.  She put a pot of water on the stove to boil one evening and forgot about it but fortunately I found it before anything disastrous happened.  She was very anxious about remembering where we parked at the hospital and being able to find the car when we finished visiting my dad every day.  I tried to help her with memory and orientation tricks like using the letter of the parking level as the first letter of a word that had some meaning for her and verbally repeating the walking path from the car to the elevator several times but she had a lot of difficulty remembering these things.  Since my dad was not sure he was going to make it out of the hospital that first night he had asked me to teach my mom how to fill up the car with gas and how to use their debit card.  I tried, but she seemed overwhelmed and confused and lacked confidence in her ability to do these things independently.  My brother shared his concerns about her decline in cognitive function and I told him I thought it was most likely due to the stress of dad being in the hospital and her fear of losing him and being alone.  I fully expected her to return to her baseline once he recovered. Sadly, her cognitive decline continued at an accelerated pace.

As I reflect on our relationship, I am grateful for many things my mother taught and modeled for me. She demonstrated a strong work ethic and taking pride in what you do no matter what others think. She taught me to embrace a love of fashion although our styles are very different. She was bright and flowy, and I am much more muted and tailored. This love of fashion sparked my boot, jacket, and jewelry obsession. It also included learning how to iron.  I realize I am probably the last person on the planet who still irons, but I dislike wrinkles, and I love crisp creases. She taught me how to entertain, set a nice table, and host an enjoyable dinner party. She passed on her love of sports and as a family we enjoyed watching college and professional baseball, basketball, and football including attending many games in person. And of course, our shared love of music. I am so appreciative of these gifts my mother gave me.

Video Screen Shot by Kathy Kroening. July 2021. Newport, WA

The number of individuals living with dementia is increasing.  It is estimated that in Americans over the age of 65 there are currently 7.2 million living with dementia, with almost two-thirds of these being women. (Alzheimer’s Association, 2025) My generation, the Boomers, includes those born between 1946 and 1964.  The oldest members of this group are now approaching 80 and the youngest are in their early 60’s. (United States Census Bureau, 2025). The Boomers are entering the age when symptoms of dementia begin to show and we are a fairly large segment of the population. Estimates of the number of Americans who will be living with dementia in 2060 reach 13.8 million. Barring development of a miraculous cure this means caregiving burden and strain on the health care system will be enormous, not to mention the cost of this care that many will not be able to afford. Two-thirds of those providing care for individuals with dementia are women. (Alzheimer’s Association, 2025)

This illness takes a tremendous toll on caregivers and close family members and the estimated lifetime cost of care for an individual with dementia is a little over $400,000. (Alzheimer’s Association, 2025) The median cost for independent living facilities is $3,100 a month, for assisted living $4,995 a month, for memory care $6,200 a month, and for in-home help approximately $30 an hour. (A Place for Mom, 2024) These rates vary dramatically depending on state and city with The District of Columbia and New Jersey at the high end and Alabama and Wyoming at the low end with a gap of over $3,000 in between.  If an individual with dementia requires five years of assisted living followed by five years of memory care the median cost for that ten-year period is $671,700.00. For those without long-term care insurance, modest savings, and on a fixed income the costs will far exceed available funds.  If significant changes are made to social security and Medicare benefits, this will create additional shortfalls in funding.  If we project this cost out to the estimated number of individuals living with dementia by 2060, we are looking at a total cost of 9.27 trillion dollars. For comparison purposes, the current US national debt stands at 37.9 trillion dollars.

While lack of funding is a significant part of the challenge of receiving care for dementia, it is not the only issue. There are eight known common causes of dementia including Alzheimer’s disease, cerebrovascular disease, frontotemporal degeneration, hippocampal sclerosis, Lewy Body disease, limbic-predominant age-related TDP-43 encephalopathy, mixed pathologies, and Parkinson’s disease. (Alzheimer’s Association, 2025) Diagnosing and managing care for individuals with dementia requires specialized training. It is estimated that 18,142 geriatricians will be required in the United States to meet the needs of all individuals living with dementia in 2050.  The current number of geriatricians is approximately 7,000 and that number has not increased in the last decade. (Alzheimer’s Association, 2025) Medical providers are not entering this specialty, creating a dearth of expertise. This will most likely result in missed diagnoses, inadequate medical care, and additional strain on family members and other caregivers as they try to fill the gaps. Age, genetics, and family history contribute to the development of dementia and are not within our control. The good news is there are other risk factors that can be mitigated such as preventing traumatic brain injury, eating a healthy diet, getting regular exercise, maintaining a moderate level of cognitive and social engagement, good sleep hygiene, and decreasing your risk of hypertension and diabetes. The bad news is the disease process leading to dementia can begin up to 20 years before symptoms present. (Alzheimer’s Association, 2025)

Dementia is a significant burden for women. Of the 7.2 million American’s living with dementia, 4.8 million of those are estimated to be women.  If we add in another two-thirds of that 7.2 million as potential women caretakers that is a total 9.6 million women affected directly by dementia. That number will skyrocket in the next twenty years. Many of the women who are caretaking are working and also caring for children, grandchildren, and other family members. In order to ease this burden these women need significant support in the form of financial assistance, medical care, and respite care.  They need time for themselves to manage their own health and mental health but often do not ask for or receive it. Where will this support come from? It is a question without good answers but one that needs to be addressed and soon.  

My mother’s condition has declined significantly in the last several years.  My father, who is 92, has been providing care for her at home but she needs constant attention.  She requires prompts for everything including dressing, self-care, eating, activities, and going to sleep.  She is fearful, paranoid, and angry at times and cannot tolerate being alone. Even with in-home help my father was struggling to care for her at home, so they recently made the decision to move to an assisted living facility this year. She often does not know where she is, what is happening, who my dad is, or even who she is.  With the usual social inhibitions stripped away by the disease she often lashes out in fear and frustration, yelling, screaming, accusing, throwing things, and occasionally hitting. She becomes jealous and aggressive if my dad’s attention is diverted by anyone which means I have become a threat and a trigger.

Since my parents’ return to Washington State full-time in 2021, I have tried to visit every six weeks barring crises in my own life. I take a Friday off work, drive 5-6 hours, visit for a few hours then check in to my accommodations. I visit most of the morning and afternoon on Saturday and for a few hours on Sunday before driving home. Several months ago, my father asked me to give a sixty-minute piano recital of 50’s and 60’s music during my visits, telling me how much my mother and the other residents would enjoy it. I told him I had not performed in a recital since I was 12 and he told me not to worry about it. Easy for him to say! Now when I visit, in addition to worrying whether the very sight of me will set my mother off, I also have to deal with fairly wicked performance anxiety. What a fabulous twofer! It is a draining weekend but seeing my parents in person is helpful for me and my dad really appreciates my visits. And as far as the recital goes, the residents really do enjoy it but the best part is, even if my mom has no idea who I am, she smiles and sings along, and for that short period of time we can be joyful together.

Photo by Kathy Kroening. September 2025. Spirit Lake, ID

I just returned from a visit this weekend. As soon as I walked into the facility, my dad whisked me into a meeting with the head nurse and the director to discuss medications and behavior management strategies.  My mother had a very difficult day on Saturday.  She did not know who she was or others around her.  She was extremely confused and did not remember much of anything which made her fearful and angry.  She lashed out with her language and tried to hit others. She made repeated statements that nobody wanted her around, everyone thought she was stupid, and we must hate her. My family and I regularly consult with the facility staff to modify her medication regime and daily routine to keep her and everyone around her safe. But the truth is, there are no magic medications or interventions and this is a lot of trial and error. As the disease progresses, so too will her current symptoms.  It is painful and heartbreaking to watch someone you care about lose their dignity and sense of self. What is it that makes each of us unique and binds us to our loved ones? Is it still there, inside her somewhere, or is it completely gone? Why does the body persist when the essence of a person ceases to exist? I can’t find her anymore, but I keep looking.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Alzheimer’s Association. (2025). Alzheimer’s Disease Facts and Figures: Alzheimer’s Dementia, 21(5). https://www.alz.org/getmedia/ef8f48f9-ad36-48ea-87f9-b74034635c1e/alzheimers-facts-and-figures.pdf

United States Census Bureau. (2025). Older Adults Outnumber Children in 11 States and Nearly Half of U.S. Counties. https://www.census.gov/newsroom/press-releases/2025/older-adults-outnumber-children.html

A Place for Mom. (2024). Cost of Long-Term Care and Senior Living. https://www.aplaceformom.com/senior-living-data/long-term-care-costs

Over the summer, Pete Hegseth, the United States Defense Secretary (recently renamed Secretary of War), reposted a videotaped interview of Doug Wilson, Pastor of Christ Church in Moscow, Idaho.  Doug Wilson Interview The interview begins with Pastor Wilson stating, “Women are the kind of people that people come out of”. The statement was shocking.  The look on the face of CNN Anchor and Chief Investigative Correspondent Pamela Brown was priceless and no doubt mirrored my own. As the interview continues, Pastor Wilson, several of his fellow pastors, and parishioners espouse the beliefs that men are the head of the household, women are subservient, and women should not hold positions of leadership. Executive Pastor Jared Longshore stated he would support repealing the 19^th Amendment of the Constitution thereby abolishing a woman’s right to vote. His rationale is “The atomization that comes with our current system is not good for humans.” (CNN, 2025) Since he did not elaborate on this statement it is impossible to understand his intent but one interpretation that aligns with the patriarchal ideology of his church is that women’s involvement in decision making causes disunity.  It would have been simpler to say that in his opinion, when women are allowed to make their own decisions, it is not good for men.

In addition to his role of Pastor at Christ Church, Doug Wilson is also a co-founder of the Communion of Reformed Evangelical Churches (CREC). Founded in 1998 this coalition of churches emphasizes the importance of creeds, confessions, and liturgies to achieve a goal of “maintaining its Reformed faith, avoiding the pitfalls of cultural relevance and political compromise that destroys our doctrinal integrity”. (CREC, n.d.)  In addition to preaching patriarchy, this Reformed faith strictly prohibits abortion, sex outside of marriage, homosexuality, and gender diversity.  Besides repealing the 19^th Amendment to the Constitution, Wilson and some of his followers also support rescinding legalization of gay marriage. A deeper dive into their website provides a more intimate look at the expectations for parishioners’ strict adherence to the doctrinal beliefs and the punishment for disobedience. Exactly how large is this following? It is difficult to find an accurate estimate of the total number of congregants but CREC lists 134 churches in 39 states in the United States (US) with the highest concentration in Texas (12), Washington (11), Idaho (8), and Virginia, Tennessee, and Florida with seven each. Internationally CREC has an additional 25 churches in 11 countries including Canada, Brazil, Australia, the British Isles, Ukraine, Poland, Russia, Japan, Bulgaria, the Czech Republic, and Hungary. Half of these churches are in Canada (7) and Ukraine (6). (CREC, n.d.) Suffice it to say CREC is extending its reach and with Hegseth on board and a new church in Washington D.C. that held its first service in July of this year, they are working hard to influence members of the current administration.  While Doug Wilson, his churches, and his beliefs are a growing force for a return to the conservative religious and patriarchal dominance of an earlier era he is not alone.  There are other individuals and organizations pushing this same agenda.

The tragic assassination of Charlie Kirk on September 10^th has drawn the spotlight to his activism and Turning Point USA (TPUSA), the organization he founded. I examined the TPUSA website looking for a mission statement to get a better sense of the organizational goals but was unable to find anything conclusive. In a brief section titled “The Fight Continues” it states the movement Kirk founded is “rooted in faith, freedom, and love of country” and raising a generation that “would NEVER SURRENDER”. (TPUSA, n.d.) The final sentence emphatically states that the organization will continue to defend the future of America until freedom prevails.  These generalities did not help me understand the beliefs or goals of Kirk or the organization.  Freedom, never surrender, and defend are certainly a unifying and mobilizing call to action but it is unclear what or who the fight is against. The most prominent features of the TPUSA homepage are the seven buttons for donation. It also includes links to upcoming events, student organizations for both high school and college students, featured content, news stories, merchandise, social media, and subscribing. A review of recent news reports and Kirk’s program Prove Me Wrong, described as a debate platform with college students, provides more substantial information about his beliefs.

At the age of 18 Kirk failed to gain admission to West Point and launched TPUSA.  His target audience was high school and college students and his initial platform focused on limited government and free markets. Over time Kirk’s organization began producing shows that rivaled rock concerts with guest speakers from the conservative movement. These college campus rallies attracted large numbers of young voters.  He supported a gun rights, antiabortion, patriarchal, conservative agenda that has influenced a generation. (Cappelletti & Cooper, 2025) He expanded his reach with a nationally syndicated podcast, speaking engagements, and publishing several books with his estimated net worth at the time of his death approximately $12 million.

Clicking through several of the Prove Me Wrong clips on the TPUSA website was illuminating and provided a glimpse of Kirk’s personality and style of interaction.  In one clip, a female college student asks how she can facilitate conservativism among women.  Kirk agrees with her that liberal women have “lots of daddy issues” and reference is made to a prior speech where Kirk linked these women with sexual promiscuity. He also states “We have more single women in their early 30’s that are the most depressed, suicidal, anxious, lonely in America’s history because of the biological clock that’s going off and they realize that they’re not going to be able to have kids, that they are not as desirable in the dating market or the dating pool and so they start to lash out on the rest of society.”  His answer to this problem is for women to “reject the siren song of modernity and have lots of kids”. (TPUSA, n.d.) Kirk Prove Me Wrong Clip His delivery of this material is authoritative and inflammatory at times, more so in clips where students disagree with his ideas.

Kirk’s Prove Me Wrong clips are described as debates. True debate is very formal and structured with equal time given to participants and a requirement for providing evidence to support claims. It is also a civilized event where value is placed on the strength of a logical argument devoid of strong emotion and inflammatory language. Kirk’s videos possess none of these qualities. In the referenced video clip, Kirk’s debate partner agrees with his views, his presentation is informal and lacks evidence to support his claims.  This lack of evidence may have been an oversight on his part or an intentional omission because there is no evidence to support his claims. At the time of this writing, the First Amendment to the Constitution still protects free speech in this country and I support it wholeheartedly.  Everyone has a right to express their views without retaliation but care should be taken in identifying statements as fact versus personal opinion. People can take personal responsibility for expressing their opinions thoughtfully without the use of intentionally offensive, inflammatory, or derogatory language. If we expect this standard and enforce accountability through social norms we would live in very different world.

Wilson and Kirk’s attempts to influence men to adopt conservative values and increase the power and influence of men has far reaching implications. Could their strategy also involve using women to push this agenda on other women? The tradwife (traditional wife) movement has been gaining momentum over the last five years, thanks in large part to a growing presence on social media. The Tradwives Club, created in the summer of 2021 described itself as “creating and cultivating a brand centered around counter-cultural values rooted in traditional Truths” focusing on “faith, family, femininity, marriage, and gender roles”. (Sykes & Hopner, 2024) There is a strong identification as feminine not feminist among Tradwives and their supporters. The word feminine refers to characteristics typically associated with women or girls. (Meriam-Webster, n.d.)  The definition itself is not a checklist of attributes that make someone feminine.  The word feminist generally refers to support for social, economic, and political equality for women and men. (Meriam-Webster, n.d.) There is nothing in these definitions to indicate they are mutually exclusive. I would argue that a woman who embraces feminist beliefs can also have strong faith, be a loving and supportive partner and parent, enjoy an engaging career of her choice, and be feminine.  It is distasteful enough to have men define women’s femininity but it is disheartening and divisive when women try to dictate femininity to each other.

Women in the tradwife movement have capitalized on the influencer culture and on-line marketing aspects of social media.  They have amassed significant followers and, in some instances, turned a nice profit with advertising, promotions, and on-line businesses aimed at increasing the presence of the movement. (Sykes & Hopner, 2024) On the surface their message may seem harmless but the movement is fueled by a larger agenda with enough political backing to have devastating consequences for women’s rights.  For several centuries after the founding of this country, women’s submissive status was not just a social construction but a legal reality as well.  The laws of coverture prevented women from having their own money and owning property. Legally women were not even protected from emotional, physical, or sexual mistreatment from their husbands with this denial of bodily autonomy extending to decisions about pregnancy. Many women were allowed to own property beginning in the early 1900’s and all women earned the right to vote in 1920. Abortion became legal in 1973. Women were finally allowed to obtain credit cards in their own name in 1974. Marital rape was not legally punishable in all US states until 1993. (Beatty, 2024) While the Trad Wife Movement does not specifically advocate revocation of these rights, the push for a return to patriarchy makes them vulnerable.  We have already seen the reversal of Roe v Wade in 2022, something many thought could never happen and there is public debate about repealing the 19^th Amendment to the Constitution. This would destroy the hard work of generations of women who fought valiantly for these rights. The scariest part of this potential outcome is not the setback but the realization that once we go back, we may never recover.

In an interesting deep dive analysis of three tradwife influencers Proctor (2022) suggests that in addition to espousing a return to patriarchy, the tradwife movement is attractive to and reinforces a framework of systemic white supremacy. While most tradwives do not claim alliance with white supremacist organizations the movement contains ingredients of both systemic white supremacy and misogyny. While there do not appear to be direct ties between Doug Wilson, Charlie Kirk, and the tradwife movement with far-right extremist groups like the Proud Boys, they share common beliefs and goals and the former can certainly serve as an introduction to this content and a gateway to the latter.  Taken together these organizations and groups reach a large number of Americans which is a sobering thought.

What is behind this movement? There are most likely multiple factors involved but a return to values of an earlier era will not solve the current problems plaguing the United States however reviewing and learning from our past can be quite valuable.  As a country we have certainly made mistakes along the way but our accomplishments are remarkable and our potential is still viable. The founding of our country was an escape from the monarchy in Britain.  As stated by James Madison “The accumulation of all powers, legislative, executive, and judiciary, in the same hands, whether of one, a few, or many, and whether hereditary, self-appointed, or elective, may justly be pronounced the very definition of tyranny.” (Madison, 1788) The concern was continuing this type of government in the newly formed country would lead to abuse of power and infringement on individual rights. Key principles for the new government included protection of individual rights, government by and for the people, separation of power using multiple branches of government for checks and balances, and separation of church and state. The current movements pushing patriarchy, religious and white nationalism, and extremism are gaining traction and moving us further away from democracy and closer to autocracy, infringing on the rights of many.  Can we return to an America where every person is free to express their opinion without retaliation, an America where free will still exists rather than forced choice through coercion, threat, blackmail, and violence?

Photo by Kathy Kroening. Kalaloch, Olympic National Park, WA. December 2017

If we want to protect the rights of the many not just the few, there is some serious work to be done. For women, we are at a precarious tipping point when it comes to protecting our rights. It is imperative that women unite in advocating for every woman’s freedom to make the choices that work best for her. Can we invite our husbands, partners, fathers, brothers, sons, friends, and colleagues who share our views to join us?  Can we celebrate our diversity and what it brings to our country and work together to protect the rights of everyone?  Can we follow in the footsteps of those whose bravery and boldness shaped this country into a proud democracy celebrating our diversity and our freedom? Now is the time to persevere and push forward because there really is no going back.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Beatty, J. (2024). The Truth About the Past That ‘Tradwives’ Want to Revive. Made By History. Time.com. https://time.com/6962381/tradwives-history/

Cappelletti, J. & Cooper, J. (2025). How Charlie Kirk Helped Shape a Conservative Force for a New Generation. PBS News. https://www.pbs.org/newshour/politics/how-charlie-kirk-helped-shape-a-conservative-force-for-a-new-generation

CNN (2025, August 8). Christian Nationalist Pastor Says Women are the Kind of People that People Come out of. [Video] CNN.com https://www.cnn.com/2025/08/08/us/video/christian-nationalist-doug-wilson-women-pam-brown-vrtc

Communion of Reformed Evangelical Churches (n.d.) The Story. CREChurces.org https://crechurches.org/story/

Madison, J. (1788). The Federalist Papers: No. 47. https://avalon.law.yale.edu/18th_century/fed47.asp

Merriam-Webster. (n.d.). Merriam-Webster.com dictionary. Retrieved October 11, 2025, from https://www.merriam-webster.com/dictionary/feminine

Merriam-Webster. (n.d.). Merriam-Webster.com dictionary. Retrieved October 11, 2025, from https://www.merriam-webster.com/dictionary/feminism

Proctor, D. (2022). The #Tradwife Persona and the Rise of Radicalized White Domesticity. Persona Studies, 8(2), 7-26. https://www.researchgate.net/publication/368268095_The_Tradwife_Persona_and_the_Rise_of_Radicalized_Domesticity

Sykes, S. & Hopner, V. (2024) Tradwives: Right Wing Social Media Influencers. Journal of Contemporary Ethnography, 53(4), 453-487. https://journals.sagepub.com/doi/10.1177/08912416241246273

Turning Point USA (n.d.). How the Left is Failing Women [Video} TPUSA.com https://youtu.be/q7mG8Ae47qw

Turning Point USA (n.d.). The Fight Continues. TPUSA website. https://tpusa.com/

Adam and Eve. In this creation story from the primary religious text that many people in this country embrace, everything was rosy for the first couple until the woman destroyed it. Adam and Eve lived a simple and blissful life in the plentiful Garden of Eden until a serpent enticed Eve to eat fruit from the forbidden tree of knowledge of good and evil which she shared with Adam. The Father’s punishment for Eve was that all women would endure painful childbirth and become submissive to their male partners, condemned to lives of pain and suffering. According to this narrative, women were doomed from the start. Eve, seeking to better herself by acquiring knowledge and becoming enlightened, not only loses her identity and independence, but suffers the wrath of her father and shame, blame, and anger from her mate. Did this narrative insidiously weave itself into the fabric of society creating oppression, degradation, and control of women as a baseline that men in power fight to maintain?

It is important to keep in mind that I am speaking about beliefs at the societal level, not those of individual men and women, more a kind of collective unconscious. There are certainly many men in this country who respect women and are more than willing to support and partner with them in domestic and occupational endeavors. And there are many women who desire and support equality. How did the belief that women are lesser than men become so ingrained in this collective unconscious and what actions have kept it firmly anchored in this country for so long? Is there a clue in the simple naming of a body part that happened centuries ago?

The word penis comes from the same Latin word meaning tail. It was most likely coined in the late 1600’s by men of medicine, borrowing from existing language. This would seem an odd choice given the idiom “tail between one’s legs” which refers to behavior in dogs expressing fear and submission. Perhaps on a subconscious level the term was representative of men’s fear of women’s power. All men are born of women and the ability to create life is certainly one power women have that men do not. Yes, men contribute sperm necessary to fertilize an ovum but a woman’s body feeds and nurtures the developing fetus before delivering the newborn into this world. Now that is power!

As babies and boys, men need and are dependent upon their mothers. They are loved, fed, bathed, dressed, nurtured, cuddled, kissed, comforted by a woman and rely on her for everything. As they grow, there is a gradual separation from mother, accelerating rapidly during puberty and adolescence as boys explore and experiment with what it means to be a man. Is it possible the pain of rejecting dependence on mother creates a subconscious resentment of this need that is projected on all women for the rest of a man’s life?

Within the context of heterosexual relationships, men need women more than women need men. In general, men’s sex drive is higher than women’s. (Laan et al., 2021) Despite negative economic costs and often sole childcare responsibility more women initiate divorce, report increased happiness post-divorce, and do not remarry, compared to men. (Parker et al., 2022) In marriage women perform more of the domestic chores and organize social engagements for the couple. (Hess et al., 2020; Robins & Mason, 2024) After divorce men are more socially isolated and less capable of basic domestic chores such as shopping, cooking, cleaning, and organizing their personal lives. Do these discrepancies further highlight women’s independence and men’s dependence, adding to the deeply seated subconscious resentment and potentially escalating to hatred?

While this very brief examination of possible psychological factors driving oppression of women may contribute to understanding societal beliefs, a better target for intervention is the behavioral choices that are made as a result of these beliefs. I am a psychiatric nurse practitioner with over 40 years of experience in the field. I have worked inpatient psychiatry in the military, adult jails and prisons, the juvenile justice system, and several of the most acute psychiatric units in a four-state region in the Pacific Northwest. I have also worked in outpatient mental health with adults living with chronic mental illness in downtown Seattle as well as teenagers with complex medical and psychiatric symptoms for the last 22 years. I have seen the dregs of human behavior but I have also seen the incredible potential of the human mind. As humans, one advantage we possess over other species is our ability to critically analyze information and make informed choices about our behavior. A brief glance at the news headlines demonstrates our tendency toward hatred, violence, and destruction at this moment in time, but we are also capable of great compassion, empathy, respect, and creative problem solving. Let us examine some of the behavioral tactics used to continue oppression of women.

Women have often been called the weaker sex. Are men really stronger than women? Physically, male bodies have advantages in terms of bone structure, muscle mass, and lean body mass that provide a physiological edge. In a small but interesting study comparing male and female athletes who participate in strength and power events, multiple measures concluded that men possessed a significant advantage in maximal strength and power. (Bartolomei et al., 2021) While most men are physically stronger than most women, this does not prevent women from developing significant physical strength. This strength difference may not be something most people give much thought to, but any woman who has ever been victimized by a man either physically, sexually, or both, experiences decreased confidence in her own ability to defend and protect herself. This perceptual shift can lead to chronic feelings of increased vulnerability and fear.

In the behavioral realm, most people tend to use what works for them to get what they want and need. If men view their physical strength as a primary asset, they are more likely to use it as a means of control with other men and women. This masculine approach of power, coercion, and control rather than communication, compassion, and compromise is far too prevalent. Manifestations of this include rape, intimate partner violence, human trafficking, hate crimes, mass shootings, assassinations, and war, with weapons being a phallic extension of masculine power and domination.

Current statistics on rape in the United States are difficult to find and interpret. Each year the Federal Bureau of Investigation (FBI) publishes a report on crime compiled from data submitted by law enforcement agencies around the country. The cover sheet for this report states one rape occurs every 4.1 minutes (approximately 131,400 rapes in a year based on the current US population) and that rape decreased by approximately 5% in 2024. Statistics and graphs in this document include reported number of offenses for aggravated assault with a weapon, robbery with a weapon, burglary, motor vehicle theft, violent crime and property crime clearances and arrests, hate crimes, and assault and murder of law enforcement officers but not for rape. Buried on page 23 of this 42-page report it is stated that the estimated rate of rape in 2024 was 37.5 per 100,000 inhabitants or approximately 12,750 which is a gross underestimate compared to the statistic reported on the cover sheet. (United States Department of Justice, 2025) This rate seems low given other reported statistics over the years. According to the Rape, Abuse & Incest National Network (RAINN) the number of estimated rapes in the US each year is closer to 423,020. Their estimate is that a rape occurs in the US every 74 seconds. (RAINN, n.d.) This is probably an underestimate but even so, if you take a minute to think about this, in the 20 minutes it takes to read this post, approximately 16 rapes will be committed in this country.

The reasons for the lack of accurate data on rape vary. In the case of a report like the one compiled by the FBI, in order to be included in their statistics the rape would need to be reported to law enforcement officials and every law enforcement agency in every jurisdiction in the country would need to be included in the report. While men are also sexually assaulted, women make up the majority of victims and in the FBI report the gender of victims was not specified. When surveys are used to collect such sensitive data, many respondents do not feel comfortable disclosing this information to a stranger. RAINN states only one in three victims of rape report it and 80% of college women do not report sexual assault. (RAINN, n.d.) Rape is often not reported for fear the victim will not be believed or will suffer retaliation from the offender. Even if a woman reports the rape she is often blamed for the act, accused of lying, and publicly ridiculed and humiliated.

The legal system in this country works against women when it comes to prosecution of crimes against her body, sending the message that her body does not belong to her and can be used and abused by others without penalty or recrimination. Many cases hinge on whether the jury believes the man’s or the woman’s testimony. Her life will be scrutinized, her character assassinated, her fashion choices demonized, her behavior questioned, and her intentions filtered through the lens of patriarchal beliefs about women. If there is DNA evidence to establish that intercourse happened between the perpetrator and victim, the sex will be labeled consensual. If there is physical evidence of forced intercourse such as vaginal or anal tearing, the prosecution will state the woman liked rough sex. RAINN states out of 1000 sexual assaults, 50 reports lead to an arrest, 28 to felony conviction with only 25% being sentenced to incarceration. This equates with roughly 98% of perpetrators experiencing no legal consequences. (RAINN, n.d.) The abysmal response from the legal system reinforces this behavior that continues the violation, degradation, and oppression of women.

As a young nursing student, I remember learning that rape was motivated by power and control. There was a distinct attempt to separate it from sexual behavior which made me angry. I view this decoupling of sexual arousal from motivation as yet another patriarchal excuse to deflect criticism. It is more socially acceptable for men to be seen as asserting dominance by using their power rather than making conscious choices to act on their sexual urges violently and without consent. As a lifelong student of human behavior, I see this cognitive distortion spiraling outward with dangerous and devastating consequences. When sexual arousal becomes paired with inflicting violence and pain on a sexual partner this behavior escalates over time and is reinforced each time a perpetrator receives sexual gratification from an aggressive act of violation.

In order to better understand this relationship between violence and sexual arousal, think about Pavlov’s experiments with dogs in the late 1800’s. He paired an unconditioned stimulus with a neutral stimulus in an attempt to make it a conditioned stimulus. In his experiments the unconditioned stimulus was food, which caused salivation in the dogs, a natural response to food. He added ringing a bell (neutral stimulus) shortly before presenting the food and eventually the dogs would salivate when the bell rang, even if no food was presented, making the bell a conditioned stimulus. (Sanvictores et al., 2024) In the case of sexual arousal, it is an unconditioned stimulus, a natural response humans have towards other people they find attractive. When a violent act like rape is paired with arousal the violence becomes a conditioned stimulus. While it is possible to uncouple the conditioned stimulus from the behavioral response it takes a tremendous amount of work over an extended period of time and success depends on the individual’s motivation to make a change.

The evidence presented above demonstrates that while rape may be used as a form of power and control against women it is also about sex. It involves sexual arousal on the part of the man and reinforces gratification from sexual violence against women. The consequence for these men is the increasing need to continue seeking sexual gratification through violent behavior. The consequences for the women they victimize include Post Traumatic Stress Disorder (50-60%), sleep difficulty, substance use, anxiety, depression, suicidal thoughts, shame, sexual dysfunction, and sexual avoidance, all of which interfere significantly in daily functioning and relationships. (Serrano-Rodriguez et al., 2024). Rape has devastating consequences for women and is seemingly tolerated in our society. When sexual assault occurs within the context of intimate partner violence, the level of devastation is magnified.

Intimate partner violence is another form of power and control. The majority of perpetrators are men and their victims are women although men can be victims and it is not exclusive to heterosexual relationships. It includes sexual and physical violence, psychological aggression, or stalking by a current or former intimate partner. Estimates vary between 30% and 47% of women experiencing intimate partner violence during their lifetime. It is the leading cause of death by homicide among women in the United States. (Maza et al., 2021; Leemis et al., 2022) Within the spectrum of intimate partner violence of women, lifetime occurrence of physical violence is 42%, sexual violence 20%, and stalking 13.5%. Acts of emotional aggression by perpetrators include control of finances, isolation from family and friends, demanding to know where the woman is at all times, threatening physical harm, threatening suicide, making decisions for the woman, and destroying things that are important to her. (Leemis et al., 2022)

Intimate partner violence produces significant health and mental health consequences for women and any children in the home. Despite the substantial consequences, as a society we have not made much progress in addressing the problem. In her excellent book No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us, Rachel Louise Snyder details many of the roadblocks to tackling this issue. She reminds us there were laws in place to protect animals from cruelty for several decades before laws were created to protect wives and there were nearly three times more pet shelters than domestic violence shelters in the US in the 1990s. (p. 12) The first legal protection in the US was the Family Violence Prevention and Services Act  which was not passed until 1984. (p. 13) In 1990, then Senator Biden introduced the Violence Against Women Act that took four years to pass and be enacted into law. (p. 14) As in the case of rape, victims of intimate partner violence are often not believed or treated respectfully in our legal system and many perpetrators walk away with minimal consequences. (p. 11)

Perhaps the most damaging social judgment of women who are victims of intimate partner violence is the common question “Why don’t they just leave”? There are many reasons women stay: they love their partner; they have no job or income to support themselves and their children; they have nowhere else to go; they have been told repeatedly they are worthless and no one else will ever want or love them; they know if they leave their partner will find them and the consequences will be brutal. The the most dangerous time in an intimate partner violence relationship is when a woman leaves. Years of psychological, physical, and sexual abuse, lack of resources, isolation, and threats of violence and death keep women trapped in these relationships.

Photo by Kathy Kroening. View from summit of Mt. Spokane (elevation 5,883 feet). August 2022

Given the scope of violence against women in this country how do we begin to make changes? Knowledge is power. Can we educate men and women about safe, supportive, and respectful relationships and begin this education in elementary school? Can we acknowledge each individual makes conscious choices about their behavior and demand accountability at the personal level and within our judicial system? A woman’s body, behavior, and attire are not responsible for men choosing to act on their sexual desires. Can we step out of our day to day lives and make the subconscious conscious, acknowledging the ongoing oppression, violence, degradation, and control of women? Can we see the forest for the trees? And most importantly, can women come together as a strong and resilient community to support and protect each other, unite in our advocacy for our rights, and own our power?

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Bartolomei, S., Grillone, G., Michele, R., & Cortesi, M. (2021) A Comparison Between Male and Female Athletes in Relative Strength and Power Performances. Journal of Functional Morphology and Kinesiology, 6(1). https://pmc.ncbi.nlm.nih.gov/articles/PMC7930971/

Hess, C., Ahmed, T., & Hayes, J. (2020). Providing Unpaid Household and Care Work in the United States: Uncovering Inequality. Institute for Women’s Policy Research. IWPR #C487. https://iwpr.org/wp-content/uploads/2020/01/IWPR-Providing-Unpaid-Household-and-Care-Work-in-the-United-States-Uncovering-Inequality.pdf

Laan, E., Klein, V., Werner, M., van Lunsen, R., & Janssen, E. (2021). In Pursuit of Pleasure: A Biopsychosocial Perspective on Sexual Pleasure and Gender. International Journal of Sexual Health, 33(4). https://www.tandfonline.com/doi/full/10.1080/19317611.2021.1965689#abstract

Leemis, R., Friar, N., Khatiwada, S., Chen, M., Kresnow, M., Smith, S., Caslin, S., & Basile, K. (2022). The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Intimate Partner Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/nisvs/documentation/NISVSReportonIPV_2022.pdf

Mazza, M., Marano, G., Gonsalez del Castillo, A., Chieffo, D., Monti, L., Janiri, D., Moccia, L., & Sani, G. (2021). Intimate Partner Violence: A Loop of Abuse, Depression and Victimization. World Journal of Psychiatry, 11(6), 215-221. https://pmc.ncbi.nlm.nih.gov/articles/PMC8209536/

Parker, G., Durante, K., Hill, S., Haselton, M. (2022). Why Women Choose Divorce: An Evolutionary Perspective. Current Opinion in Psychology, 43, 300-306. https://www.sciencedirect.com/science/article/pii/S2352250X21001299

Rape, Abuse, & Incest National Network. (n.d.). Facts and Statistics: The Scope of the Problem. https://rainn.org/get-informed/facts-statistics-the-scope-of-the-problem/

Sanvictores, T., Mahabadi, N., & Rehman, C. (2024). Classical Conditioning. StatPearls. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK470326/

Serrano-Rodriguez, E., Luque-Ribelles, V., & Hervias-Parejo, V. (2024). Psychosocial Consequences of Sexual Assault on Women: A Scoping Review. Archives of Sexual Behavior, 54(1), 231-258. https://pmc.ncbi.nlm.nih.gov/articles/PMC11782293/

Snyder, R.L. (2019). No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us. Bloomsbury Publishing.

United States Department of Justice – Federal Bureau of Investigation. (2025). Uniform Crime Reporting Program, Summary of Reported Crimes in the Nation, 2024. https://cde.ucr.cjis.gov/LATEST/webapp/#/pages/explorer/crime/special-reports

A Man’s World

Scientific estimates place hominins (our ancestors) on the earth approximately six million years ago. Since the dawn of time, humans have lived in a man’s world.  Men protected women and children from predators and hunted to provide food.  Women prepared food, gathered roots and berries if available, fetched water, raised children, sewed, tended to the sick, and kept living spaces clean. The most dominant and powerful males had their choice of females. The females competed among each other for the attention of the dominant males in order to secure protection, food, and status provided by the male’s position within the social group.  Sound familiar?

When the United States was founded and the Declaration of Independence signed in 1776, we were still living in a man’s world.  Women were considered property. When a woman married, she lost her legal identity.  Women were not allowed to own property, control their own money, or sign legal documents.  If a woman was unmarried her father, brothers, and other male family members assumed control over her affairs.  It would take 144 years for women to secure voting rights, the last 70 years of that fight very divisive and destructive.

Prior to the second World War women in the work force were employed primarily as domestic servants, nurses, teachers, and clerical workers. Given the devaluation of these jobs, women earned less and received fewer benefits than men.  There was much societal stigma about married women working.  The argument was they were supported by their husbands and did not need to work and they would be taking jobs away from men who needed to support their families.  Prior to the start of the war only 15% of married women were employed while half of single women were working.  That all changed as the United States entered World War II. (Rotondi, 2019)   

Women were recruited to fill manufacturing positions left behind by the men who entered military service and joined the fight.  Women also took many jobs created to support the war effort including ship building, munitions assembly, and farming.  Here in the Pacific Northwest Portland, Oregon and Vancouver, Washington became a hub for American shipbuilding between 1941 and 1944. During this time the area absorbed close to a quarter of a million migrants to support this effort.  Approximately 25 percent of those employed were women who worked as burners, welders, shipfitters, and electricians.  Women were admitted into labor unions, were well compensated earning equal pay for equal work, and were supported by the creation of government funded on site childcare facilities that operated around the clock to accommodate shift work.  Pre-cooked meals were also available for purchase at these centers so providing dinner at the end of a long shift required much less effort. While women benefitted tremendously from these work opportunities, helping to fill the employment gap and contribute to the war effort, discrimination in the workplace was alive and well. (Blair, 2001, pp. 158-179)

Women were ridiculed, ogled, and whistled at on the job.  Rumors were circulated that welding caused sterility in women.  Strict regulations on work attire, while focused on safety, were also meant to camouflage the female body lest it be a temptation to men in the workplace.  Because training was short and welding was an early step in the shipbuilding process, there was an overrepresentation of women in welding but they were underrepresented in other major crafts like loftsman, electrician, and rigger and as supervisors.  A significant number of women were hired as helpers, jobs that were necessary but not of interest to men.  Despite their job title, many women actually spent much of their time sweeping and cleaning up.  Women over the age of 35 were thought to lack the strength and stamina to perform welding and the majority of “older women” were assigned helper jobs.  There is some evidence to suggest that discrimination existed even within the same job category.  Women welders were more often tack-welders, temporarily securing pieces that would later be permanently joined by production welders who were predominantly men.  Although women entered the man’s world of shipbuilding temporarily, the gendered division of labor maintained the status quo. (Blair, 2001, pp. 158-179)

Many women who worked in the shipyards wished to maintain their employment after the war ended.  There was strong pressure from men for women to return to their domestic roles and employment opportunities declined dramatically.  Not much thought was given to the needs of the large number of women who became unemployed quite quickly at the end of the war.  It was assumed they would all be very happy to return to domestic bliss.  If they needed or wanted to continue working the only options were the low paying jobs that had traditionally been filled by women prior to the war. (Blair, 2001, 158-179) As always, women stepped up when they were needed, but never quite received the respect, recognition, and validation deserved for their contributions.  And as usual, when they were no longer needed, they became invisible again.

How much progress have we made towards equal pay for equal work in the last 80 years? Not enough. In 2023 women working full time earned 83.6% of their male counterpart’s salary.  Women made less than men in the top 20 male dominated occupations including software developers, construction workers, carpenters, chief executives, cooks, and technology employees. Women also made less than men in the top 20 female dominated occupations including teachers, nurses, managers, secretaries, accountants, maids, housekeepers, receptionists, and education and childcare administrators. (Institute for Women’s Policy Research, 2024) Women professional athletes earn substantially less than their male counterparts.  Looking at basketball, the highest paid men’s basketball player earns a salary of 59.61 million dollars for a single season. This does not include endorsements. (Sports Reference, 2025) The highest paid women’s basketball player earns $249,244 for a single season.  This also does not include endorsements. (Her Hoops Stats, 2025) In the entertainment industry, women authors, actors, directors, musicians, and artists earn less than their male counterparts.  When it comes to compensation, we are still living in a man’s world.

What about women in leadership? Only 10.4% of Fortune 500 companies had women CEOs in 2024. (Women Business Collaborative, 2024) The current United States Congress is made up of 26% women in the Senate and 29% women in the House of Representatives. (Center for American Women and Politics (CAWP), 2025) Twenty six percent of governors in the U.S. are women. (Navarre & Kronenberg, 2025) In US cities with a population over 30,000 residents, 26.8% of mayors were women in 2024. (CAWP, 2024) Only one woman has ever been elected vice president of the United States and we have yet to elect a woman president.  Among United Nations countries, 78 have had women serving as head of state or government. (Warnes, 2024) Why do women continue to be under-represented in leadership positions in this country despite no evidence to suggest they lack the intellect, skills, or motivation to excel and succeed? To answer this question, we need to examine long standing cultural beliefs and behaviors that lead to the devaluation and oppression of women.

Women’s work has always been devalued, whether it is in the home or the workplace.  Depending on the study, women spend between 37 to 67 percent more time than men engaged in unpaid household and care-taking work. (Hess et al., 2020; Robins & Mason, 2024).  There have been many attempts to attach monetary value to this work and these calculations vary significantly.  When women provide childcare, transport children to and from school, activities, and appointments, keep track of and schedule medical, dental, and eye appointments, perform house and yard work, shop, cook, and manage finances, the cost savings to the family are tremendous.  The toll it takes on the woman’s health can also be quite significant.  Adding caretaking of adult family members or children with special needs and the woman working part or full time magnifies the stress level dramatically.

The contributions of women are often not recognized or validated by male partners or society. If a woman decides to focus on family she is often considered lacking in intellect, skills, and motivation and judged harshly for not contributing to the family income. If a woman decides to combine work and family she is often considered lacking in maternal skills and judged negatively for neglecting home and family.  Juggling work and family may require choosing part-time work, increased use of sick days to attend to the needs of children or other family members, and the inability to work long hours, overtime, weekends, or shift work.  All of these limit a woman’s earning potential and advancement opportunities over the course of her lifetime, things that don’t interfere in the careers of most men.  If a woman does not have children, either by choice or fertility issues, negative assumptions are often made about her femininity and nurturing abilities. The bottom line seems to be that whatever choice women make they will be judged as inadequate.  This judgement comes not just from men but sadly from other women as well.

This long-standing gender discrimination in the professional realm is but one form of societal oppression of women. Additional cultural influences keep women divided and force them to compete in line with the idiom “divide and conquer”. While this may seem coincidental it is a deliberate strategy used by men in positions of power in industry. Although women spend more money on fashion and beauty products these industries are still dominated by men. (US Bureau of Labor Statistics, 2025; Llewellyn-Waters, 2022) Marketing, design, and media are fueled by male-driven expectations of the expression of femininity. Women far exceed men in spending on cosmetic surgery. In 2024 women accounted for 97-100% of breast procedures, 90-100% of body procedures, 66-93% of facial procedures, and 84-97% of minimally invasive procedures such as Botox, fillers, and other skin treatments.  Women in the 40 to 54-year age bracket topped spending in 2024 with $572,819 spent on cosmetic surgeries of the breast, body, and face and $10,793,639 spent on minimally invasive cosmetic procedures. (American Society of Plastic Surgeons, 2024) For decades women have outspent men in the diet and weight loss industry. In the 2024 Gallup Annual Health and Healthcare Survey, 49% of women believed they were overweight compared to 38% of men. (Brenan, 2024)   

The truth is women outspend men on clothing and accessories, hair care, skin care, make-up, nails, cosmetic surgery, and diet and weight loss.  Part of this is due to the “pink tax”, a gender-based economic strategy inflating the price of products and services for women but not men.  This covers a wide range including cosmetics, hair care, and clothing. A larger culprit is the messaging women receive from multiple sources throughout their lifetime that they are not pretty enough, thin enough, feminine enough, sexy enough, or just not enough. Our world is obsessed with looks but this is only a superficial measure of a person. Bodies come in different shapes and sizes.  Bodies age.  Tissue loses elasticity, skin becomes lined, muscle mass declines, and fat is redistributed.  These are normal age-related changes.  Instead of shaming, blaming, altering, and covering up can we focus on making changes that lead to optimal physical and mental wellbeing?

Optimal mental health includes feeling good about your body, your looks, your personal strengths and talents, your contributions, and the way you present yourself to the world. Given the long history of male control of the fashion and cosmetic industries, are women’s choices truly independent or have they been shaped by men for so long that we can’t tell the difference anymore?  This masculine dominated picture of femininity creates constant comparison, competition and judgment among many girls and women eroding their self-esteem along the way.  How do we begin to alter the story and edit the narrative to include women’s voices and views? 

In order to affect any kind of change, women need to value, nurture, and support themselves and each other. Focusing inward first, validating strengths and worth, nurturing the soul and creating space to reflect are important steps for all women individually. This can lead to the extension of respect, validation, and nurturing to other women, ending the constant comparison and competition. When women come together as a community with the common goal to advocate for the rights of all women, we will have the power to move mountains.

Photo by Jeff Barreca. View of Mt. Rainier from Pinnacle Peak. Mt. Rainier National Park, WA. July 2014

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

American Society of Plastic Surgeons. (2024). Procedural Statistics Report. https://www.plasticsurgery.org/documents/news/statistics/2024/plastic-surgery-statistics-report-2024.pdf

Blair, K. (Ed.). (2001). Women in Pacific Northwest History (rev. ed.). University of Washington Press.

Brenan, M. (2024). 43% of Americans Say They are Overweight; 55% Want to Slim Down. Gallup. https://news.gallup.com/poll/654425/americans-say-overweight-slim-down.aspx

Center for American Women and Politics. (2024) Women Mayors in U.S. Cities in 2024. Rutgers-New Brunswick, Eagleston Institute of Politics. https://cawp.rutgers.edu/facts/levels-office/local/women-mayors-us-cities-2024

Center for American Women and Politics. (2025) Women Serving in the 119^th Congress. Rutgers-New Brunswick, Eagleston Institute of Politics. https://cawp.rutgers.edu/facts/levels-office/congress/women-serving-119th-congress-2025-2027

Her Hoops Stats. (2025) WNBA Salary Cap Database. https://herhoopstats.com/salary-cap-sheet/wnba/players/salary_2025/stats_2024/

Hess, C., Ahmed, T., & Hayes, J. (2020). Providing Unpaid Household and Care Work in the United States: Uncovering Inequality.  Institute for Women’s Policy Research. IWPR #C487.  https://iwpr.org/wp-content/uploads/2020/01/IWPR-Providing-Unpaid-Household-and-Care-Work-in-the-United-States-Uncovering-Inequality.pdf

Institute for Women’s Policy Research. (2024). Women Earn Less than Men Whether They Work in the Same or Different Occupations. IWPR #C521. https://iwpr.org/wp-content/uploads/2024/03/Occupational-Wage-Gap-2024-Fact-Sheet-1.pdf

Llewellyn-Waters, H. (2022). Looking in the Mirror: Kickstarting the Conversation on Diversity, Equity, and Inclusion in the Beauty Industry. The MBS Group. https://www.thembsgroup.co.uk/internal/looking-in-the-mirror-kickstarting-the-conversation-on-diversity-equity-and-inclusion-in-the-beauty-industry/

Navarre, B. & Kronenberg, A. (2025). Here Are the States with Women Governors. U.S. News & World Report. https://www.usnews.com/news/best-states/slideshows/states-with-female-governors

Robins, K & Mason, J. (2024). Americans’ Unpaid Caregiving is Worth More than $1 Trillion Annually – and Women are Doing Two-Thirds of the Work. National Partnership for Women and Families. https://nationalpartnership.org/americans-unpaid-caregiving-worth-1-trillion-annually-women-two-thirds-work/

Rotman, A. & Mandel, H. (2022). Gender-Specific Wage Structure and the Gender Wage Gap in U.S. Labor Market. Social Indicators Research, 165(2):585-606. https://pmc.ncbi.nlm.nih.gov/articles/PMC9842568/

Rotondi, J. (2019). Underpaid, but Employed: How the Great Depression Affected Women. History. https://www.history.com/articles/working-women-great-depression

Sports Reference. (2025) Basketball Reference: NBA Contracts Summary. https://www.basketball-reference.com/contracts/

U.S. Bureau of Labor Statistics. (2025). TED: The Economic Daily. Apparel Data in Fashion. https://www.bls.gov/opub/ted/2025/apparel-data-in-fashion.htm

Warnes, S. (2024). The US Still has not had a Woman Leader – Here are the Countries that have. Cable News Network World. https://www.cnn.com/2024/12/22/world/women-global-leaders-countries-dg

Women Business Collaborative. (2024). Women CEO’s in America: Changing the Face of Business Leadership.  https://wbc-a4i-2024.s3.us-east-2.amazonaws.com/2024-WBC-CEO-Report-092304-0658pm-web.pdf

Vagina.  A word that conjures a myriad of images, thoughts, and feelings.  Linguistically, the word is just a medical term for part of a woman’s reproductive system.  The term originates from the same Latin word meaning sheath or scabbard.  It was coined most likely in the late 1600’s by men of medicine, borrowing from existing language.  While somewhat lacking in originality it is not difficult to understand their choice of available words.  Interestingly, the word penis comes from the same Latin word meaning tail.  This would seem an odd choice for men to have made given the idiom “tail between one’s legs” which refers to behavior in dogs expressing fear and submission. If women had been allowed to decide on terminology for their vagina, perhaps they would have considered something like via or iter, the Latin words for road and path. The number of things that go in and come out of a woman’s vagina during her lifetime is really quite staggering.  Given it is not a primary orifice for elimination of waste products from the body it gets a lot of traffic. By the time a woman reaches midlife she has most likely spent significant time with her feet in the stirrups.

Here we are several centuries after that unfortunate naming and the male perspective of the vagina as primarily a source of sexual gratification is alive and well.  While a woman’s vagina serves that purpose for a man, it is not the case for a majority of women.  Rates vary depending on the study, but many women are unable to achieve orgasm through intercourse alone and require some level of clitoral stimulation to climax.  While this information is certainly not new it has failed to have a major impact on the sexual practices of heterosexual couples to increase a woman’s enjoyment of love making.  Too often women are socialized to refrain from talking about their bodies, about sex, or asking for what they want.

Why have these archaic views of women’s sexuality continued?  If the female body, including sexuality and reproductive health remain mysterious it is only because the male dominated medical establishment and scientific research community have not deemed it important enough to explore. Despite the fact that women have been on the planet as long as men, the state of knowledge about women’s health and our sexual and reproductive health in particular lags vastly behind.  Women continue to be under-represented in all areas of health research. As mentioned in my prior posts, the current administration has implemented policies that will negatively affect women’s reproductive health in this country and worldwide.  These policies, in conjunction with recent cuts in programs, personnel, and research funding at the Centers for Disease Control and Prevention (CDC), will dramatically reduce research on women’s health, including reproductive and sexual health.

The study of women’s reproductive health is limited by a lack of knowledge about basic physiology of the uterus and menstruation. (Critchley et al., 2020) Views and messages about menstruation have not changed significantly over time with men and many women seeing it as a messy source of distress and discomfort.  An interesting survey regarding women’s views on menstruation was conducted globally in 2016 by the women’s health app Clue in conjunction with the International Women’s Health Coalition.  Responses were received from 90,000 women representing 190 countries.  Who knew there were over 5,000 euphemisms for menstruation worldwide! In this country most people are familiar with terms like aunt flo, on the rag, that time of the month, and riding the crimson wave.  The majority of survey respondents, regardless of their country of origin, reported discomfort discussing their menstrual cycle with others. (Itkowitz, 2016) In some cultures, women are forced to live separately during their menstrual cycle because they are considered unclean.  In other cultures, menarche, the first menstrual cycle, is celebrated as a girl’s transition into womanhood. This monthly flow of blood is part of the cycle of fertility, the ability to create life.  It should be revered and celebrated, not shunned and disparaged. 

Throughout a woman’s life hormone levels change.  From pre-puberty, through puberty, pregnancy, post-partum, perimenopause, menopause, to post-menopause the hormonal stew thickens and thins based on many internal and external catalysts. Too often, when a woman displays behavior that others disapprove of, this behavior becomes a manifestation of “being hormonal”. In August of 2015, after his first debate, Donald Trump said moderator Megyn Fox had “blood coming out of her eyes, blood coming out of her wherever”. (Yan, 2015) Donald Trump’s Blood Comment He made this statement in response to Fox asking him difficult questions during the debate especially related to his history of demeaning comments directed at women.  His statement, and defense of it, was met with outrage from liberals and conservatives and deemed extremely inappropriate. This very public blaming of Fox’s difficult questions on her menstrual cycle is inexcusable but sadly it happens frequently in everyday life.  Statements like “she must be on the rag” or “it must be that time of the month” are made about women in response to behavior that bothers others.  These statements are not just made by men, but many women make the same statements about each other. 

Why are women’s genuine emotions and reasonable actions so frequently blamed on hormones?  Part of this is due to long established cultural beliefs and patterns of behavior and part is due to lack of knowledge. A woman’s uterus remains mysterious to many men and women who may not give much thought to what is happening “down there” other than acknowledging menstruation and pregnancy as normal events in the course of a woman’s life. Given what is known, let us briefly examine more closely the hormonal journey of a woman’s life.

While every woman’s path through puberty is unique, hormonal changes begin approximately a year before a girl’s first menstrual cycle.  The brain, adrenal glands (situated atop the kidneys), and ovaries stimulate changes in the level of close to a dozen different hormones, leading to breast development, growth of pubic hair, a growth spurt, and menarche.  While it varies considerably, the average age of menarche is 12. (Guarneri & Kamboj, 2019) These physical changes can be distressing with the growth of breasts and spread of hips causing embarrassment, sometimes leading to a very familiar pulled in posture, a subconscious attempt to cover up.  Early and late pubertal development can also be sources of stress because at that age we all want to fit in and being different can be socially disastrous.

Once a girl reaches menarche the uterus begins its monthly cycling.  The endometrium is the lining of the uterus.  I realize most women never think about their endometrium but this tissue has some remarkable properties.  Here is a very simplified version of what happens during menstruation. Estradiol (one form of estrogen) causes an increase in vascular and endometrial tissue priming it for implantation of a fertilized ovum.  At the same time, a different hormonal cascade including follicular stimulating hormone (FSH) prepares the ovary to mature and release an ovum into the fallopian tube so it can travel to the primed uterus.  Progesterone enters the mix as a necessary hormone to establish and maintain a pregnancy. If there is no implantation of a zygote (fertilized ovum) the progesterone triggers the uterus to shed the endometrium resulting in menstruation.  This process is miraculous enough on its own but then the endometrium quickly regenerates itself in preparation for the next cycle. (Critchley et el., 2020) It is one of the many wonders of a woman’s body.

There are a number of things that can interrupt this monthly process.  Contraceptives including pills, injections, implants, and Intrauterine Devices (IUDs) can stop menstruation.  Poor nutritional status and low body weight can disrupt menstruation as can changes in circadian rhythm such as working night shifts or chronic sleep disruption. Emotional stress and trauma can alter the menstrual cycle.  Diseases of the endocrine and reproductive system can also interfere with menstruation leading to difficulty getting pregnant.  Did you know that is some situations, women living in close proximity over time can experience synchronization of their menstrual cycles?  While the exact mechanism responsible for this is undetermined, I find this connection fascinating.  Regardless of their beliefs or state of emotional connection, this biological solidarity occurs.  It would be so amazing if we could learn from our bodies and allow this synchronization to spread to an emotional connection, embracing our shared roles and experiences as women.

During pregnancy a woman’s body undergoes tremendous change, affecting multiple systems.  Hormone levels increase with estrogen peaking at a level 100 times greater than pre-pregnancy. (Jee & Sawal, 2024).  After birth there is a dramatic shift in hormones as a woman’s body creates a new post-partum baseline.  As a woman ages, her ovaries become less functional, leading to fluctuations in hormones that cause symptoms like hot flashes and changes in menstrual patterns, sleep, vaginal tissue, sexual function, mood, and cognition. The timing of this is quite variable in terms of both onset and duration.  Menopause is reached approximately one year after cessation of menses. (Delamater & Santoro, 2018) Diagnosis and treatment of perimenopausal and menopausal symptoms is in definite need of ongoing research.  There are current therapies that can be helpful in targeting these symptoms and improving quality of life but once again, because this is specific to women’s reproductive and sexual health funding and interest have limited high quality research.

While men do not experience monthly fluctuations in hormones the way women do, their hormone levels do change.  It is important to remember that the hormonal differences between men and women are not just about estrogen and testosterone.  There are over 50 hormones produced in the human body and there are no hormones that are exclusive to either men or women.  That’s right, women produce testosterone and men produce estrogen, although the levels and function are very different.  

Do hormones affect mood? Yes but, and this is a huge but, there are a multitude of other factors that also influence mood in men and women. Lack of sleep, poor nutrition including low blood sugar from not eating often enough, physical illness, mental illness, and substance use can cause changes in mood.  Any one of these by themselves is enough to disturb mood briefly but in combination they can lead to chronic mood changes.  It is also important to remember that events happening in our day-to-day environment can also affect how we feel and this is not necessarily a “bad” thing. When a woman expresses strong emotions, anger in particular, it is often blamed on “being hormonal”.  Emotions themselves are not good or bad, they just are.  Anger is one of many emotions everyone experiences.  It gets a bad rap.  What is problematic is not what a person is actually feeling, but how that person responds to the emotion. 

Let us consider an example of managing anger in a specific situation to illustrate this.  Imagine you are driving on the freeway with the flow of traffic at the posted speed limit of 60 miles per hour.  Seemingly out of nowhere, another vehicle cuts in front of you too closely causing you to brake quickly.  Fortunately, the vehicle behind you is leaving enough space that they do not rear-end you at high speed. This event triggers your fight or flight response filling your body with adrenaline and briefly causing fear about what might have just happened. This fear quickly turns to anger over the reckless behavior of the other driver who is endangering lives.  What has just happened in your body and your mind are perfectly reasonable responses to this event and not within your control.  What happens next is definitely within your control as you make conscious choices about how to respond to this incident.  You have many options available including, but not limited to: verbalizing your thoughts about the action which may include the use of expletives; taking a few deep breaths; cranking up your tunes; practicing calming self-talk; moving into a different lane; expressing your dissatisfaction with hand gestures; honking your horn to show your outrage; tail-gating the vehicle if it is still in front of you; chasing the vehicle if it has moved on; using your car as a weapon; or retrieving the gun you keep in the glove box and using it to exact revenge.  As you can see, the emotion itself is not the problem, it is the conscious behavior choices that follow that can lead to negative consequences.  We have done a poor job as a society in teaching people how to manage their emotions in ways that are not harmful to themselves or others.

Now that we have examined the role of hormones in a woman’s body, the multitude of factors that affect mood, and the concept of conscious choices in managing emotions, let us revisit women being “hormonal”.  While there is some debate about the origins of hysteria, the word has been in the world for a very long time, perhaps as many as several thousand years.  In much of the literature Hippocrates is credited with coining the term used at that time to describe any behavior in women that did not occur in and was confusing to men.  Seizure-like behavior and any extremes of emotion fell into this category.  While swooning was also closely associated with hysteria, I personally think this was more related to the tightness of corsets restricting respiration and leading to lower oxygen levels.  These behaviors were thought to be a result of a suffocation of the uterus, a drying up of the organ due to lack of intercourse, allowing it to become lighter and move throughout the body contacting other organs and systems that caused these unusual symptoms.  The cure for this of course, was to have sex with a man which would bring the uterus back where it belonged.  In some way, this belief still exists.  Have you ever heard someone say “she just needs to get laid” in response to a woman’s behavior that someone does not like? (Paulon, 2022; Madva et al., 2019)

In the Middle Ages hysteria was more likely to be attributed to witchcraft rather than a wandering uterus and of course the cure for that was being burned at the stake.  In the 19^th Century the disease would be reframed as a personality disorder and in the 20^th Century Freud developed psychoanalysis as a treatment method focusing on reintegration through revelation and expression of inner thoughts and repressed impulses which in hysteria were thought to be erotic in nature.  Today the symptoms typically associated with hysteria fit most closely with a psychiatric diagnosis called Functional Neurological Disorder, formerly Conversion Disorder for which the treatment of choice is cognitive behavioral therapy.  While no longer a diagnostic medical term, sadly the word hysteria is alive and well in the English language. (Paulon, 2022; Madva et al., 2019)

This brings us back to where we started, with language. Despite the evolution of human beings and some progress in women’s rights, why are there still so many derogatory slang words for women, seemingly many more than for men? These words range from labels of behavior like slut, whore, and hag, comparison to animals like cow, dog, pig, and bitch, to body parts like cunt.  While there are certainly derogatory slang words directed at men, many of them are terms used to demean women, thereby insulting a man by comparing him to a woman or degrading his mother.  These include terms like cunt, pussy, son of a bitch, and motherfucker. Men and women are labeled very differently when engaging in the exact same behaviors.  When a man is confident, decisive, and unapologetic he is described as ambitious and a strong leader but when a woman displays the same behavior, she is just a bitch.  When a man dresses in a way that calls attention to his physique he is described as a stud or a hunk and when a woman dresses the same way she is just a slut or a whore. Blaming women’s behavior and emotions exclusively on hormones and degrading women because of these hormonal differences is damaging in many ways. In addition to being inaccurate it is demeaning, devaluing, and shaming.  It prevents women from being taken seriously, being heard, being respected, and getting their personal, social, professional, and medical needs met. As we have seen, this is a very entrenched pattern in the history of human beings.  It needs to stop.

Photo by Kathy Kroening. Moclips, WA. June 2021

How do we turn the tide of degradation and shaming of women, women’s bodies, women’s emotions, and women’s experiences? We can start by providing girls and women with accurate information about their bodies.  We can be gentle with ourselves and others. Individually we can work towards appreciation of our own bodies, celebrating both the inside and the outside.  We can extend this appreciation and celebration to other women without judging, comparing, or competing.  We can be thoughtful about our own use of language and refrain from terminology that is offensive and degrading. We can model the type of respect we would like all women to receive. The most stunning sunsets are created by turbulent weather, wind blowing particulates into clouds reflecting light onto moving waves and sand. Let us celebrate the beautiful complexity of being hormonal.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Critchley, H., Babayev, E., Bulun, S., Clark, S., Garcia-Grau, I., Gregersen, P., Kilcoyne, A., Kim, J., Lavender, M., Marsh, E., Matteson, K., Maybin, J., Metz, C., Moreno, I., Silk, K., Sommer, M., Simon, C., Taryial, R., Taylor, H., Wagner, G., & Griffith, L. (2020). Menstruation: Science and Society. American Journal of Obstetrics and Gynecology, 223(5), 624-664. https://pmc.ncbi.nlm.nih.gov/articles/PMC7661839/

Critchley, H., Maybin, J., Armstrong, G., & Williams, A. (2020). Physiology of the Endometrium and Regulation of Menstruation. Physiological Reviews, 100(3), 945-1414. https://journals.physiology.org/doi/full/10.1152/physrev.00031.2019

Delamater, L. & Santoro, N. (2018). Management of the Perimenopause. Clinical Obstetrics and Gynecology 61(3), 419-432.  https://pmc.ncbi.nlm.nih.gov/articles/PMC6082400/#:~:text=In%20the%20SWAN%20cohort%2C%20prevalence,very%20upsetting%20life%20events44.

Guarneri, A. & Kamboj, M. (2019) Physiology of Pubertal Development in Females. Pediatric Medicine, 2(42).  https://pm.amegroups.org/article/view/4978/html

Itkowitz, K. (2016) Many Women Still Can’t Talk Openly About Their Periods – This App is Trying to Change That. The Washington Post. https://www.washingtonpost.com/news/inspired-life/wp/2016/02/28/is-aunt-flo-visiting-so-many-women-still-cant-talk-about-their-periods-openly/

Jee, S. & Sawal, A. (2024). Physiologic Change in Pregnant Women Due to Hormonal Changes. Cureus, 16(3).  https://pmc.ncbi.nlm.nih.gov/articles/PMC10993087/#:~:text=The%20levels%20of%20progesterone%20and,is%20described%20in%20Table%202.

Madva, E., Ross, D., & Cooper, J. (2019). What’s All the Hysteria About? A Modern Perspective on Functional Neurological Disorders. Biological Psychiatry, 85(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC6444349/

Paulon, M. (2022). Hysteria: Rise and Fall of a Baffling Disease. A Review on History of Ideas in Medicine. Journal of Psychopathology, 28:152-161. https://old.jpsychopathol.it/wp-content/uploads/2022/11/06_Paulon-2.pdf

Siddiqui, N., Chinchole, S., Khan, S., Bose, S., & Mishra, P. (2023). Study of Menstrual Cycle Synchrony in Female Medical Students Sharing Common Accommodation. Journal of Family Medicine and Primary Care, 12(11), 2922-2926. https://pmc.ncbi.nlm.nih.gov/articles/PMC10771221/

Wang, Z., Asokan, G., Onnela, J-P., Baird, D., Jukic, A.M., Wilcox, A., Curry, C., Fischer-Colbrie, T., Williams, M., Hauser, R., Coull, B., & Mahalingaiah, S. (2024). Menarche and Time to Cycle Regularity Among Individuals Born Between 1950 and2005 in the US. Journal of the American Medical Association Network Open, 7(5). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819141

Yan, H. (2015). Donald Trump’s Blood Comment About Megyn Kelly Draws Outrage. CNN Politics.  https://www.cnn.com/2015/08/08/politics/donald-trump-cnn-megyn-kelly-comment