Following Fifi

by John Crocker

  “Dr. Crocker, your next patient is ready, and two more are waiting,” my nurse told me gently to pull my head out of the trees. I turned away from the window, stepped into the gray-blue hallway with its fluorescent lighting, and headed to the exam room. I felt as if I had escaped to the forest, if only briefly, and been reenergized. I realized then how much I missed Gombe and nature. I wanted to be more connected to the natural rhythms of the day, to be less rushed, to breathe fresh air.

  As a child, those connections were second nature. I had spent most of my free time outdoors in the park or the backyards of neighborhood friends. My mom would shoo us out after our homework and chores were done, calling us home again for meals.

  In that moment in my office, I realized how important it still was for me to get outside into nature. I also started to accept that briefly visualizing myself in the Gombe forest or just stepping outside to go get a cup of coffee had to suffice for now.

  In comparison, in the villages around Gombe, being outside is simply a fact of life. This can pose its own hardships, but also has its gifts. Villagers maintain a primal connection with nature—part of our species’ evolutionary heritage. Modern life, however, has a way of rendering that heritage inconsequential, as I experienced with my own family. Over the years, home computers and other electronic devices increasingly began to draw all of us indoors.

  When Pat was seven, I was invited to go on a three-day school field trip to the Olympic Peninsula as a chaperone and medical practitioner. As it was a nature-oriented trip, the students were not allowed to bring any kind of electronic device.

  On the bus on the way, my son and his friend Josh complained about the policy. “I don’t get why I can’t bring my Game Boy,” Josh said, frustrated. Josh was quite sedentary at home, I knew; he and Pat both loved Mario Bros., but it was clearly one of Josh’s primary interests.

  However, once we got there, we were too busy for electronics anyway. I watched Josh come alive with enthusiasm as we trekked through the rainforest, examining lichen, banana slugs, and tiny fish in the streams. No video games—but still, I was surrounded by smiling faces and laughter. We were all so much more at ease out among the trees, without the noise of modern city life.

  Technology can also inhibit face-to-face, human-to-human communication and connection. Though it has led to invaluable advances in medical research and practice, there are also downsides. With the introduction of electronic medical records eight years ago, I can spend four or more hours a day practicing medicine by interacting with a computer screen. In response to this, I began to remind myself—as I do the families I see in my practice—to seek balance in life and to create room for experiencing nature.

  Almost universally, patients I care for describe the joy and sense of healing when they’re out in nature, whether in their own gardens, hiking in the mountains, or gazing at the evening stars. I’m convinced that a ninety-four-year-old patient of mine is alive and healthy because of his weekly trips to the Cascade Mountains to hike beside streams and wildflowers.

  Given my experiences, I understand the current movement to “rewild” our lives. I understand why I long for more nature, more spontaneous movement of my body, and more time outdoors to feel the rhythm of the day, the changing seasons, the wind, the rain, the moon, and the sun. Our genetic wiring, which has not changed much over the past few million years, is better suited to a wilder existence than the very structured and stationary lifestyle we live. My time in the African forest connected me to a more nature-based life and enabled me to understand why I felt so alive and at home in the wilder world. I encourage my patients to reconnect with this side of themselves at every opportunity.

  Even more significant to my medical practice was the image of Fifi and Freud making their way through the forest day after day, Freud prospering under the constant companionship and nurturing of his mother. Fifi’s skills as a mother were embedded in my mind much more than the biochemistry formulas and cardiogram electrophysiology I learned in medical school. The latter were important, but not as spontaneously retrievable as the behavioral lessons I had learned at Gombe, and not as human.

  One day early on in my practice, a patient named Ellen was talking to me about her two-year-old son, Sam, at his checkup. Ellen looked exhausted as the wiry blond toddler shredded the thin paper covering the exam table. When he climbed on a chair to reach for cupboard doors, she got up from her chair and whisked him back over to the exam table. He dangled over the edge and dropped back down to the floor, and we stopped talking and watched him drop Cheerios and grind them into the carpet with his feet and then go over to pull at the flexible arm of the exam light.

  Ellen sighed deeply. “I’m sorry, Dr. Crocker.”

  Even though I did not yet have children of my own, I couldn’t help but be reminded of the natural behavior of male chimps at this age. Sam was so much like Fifi’s son, the three-year-old Freud, who would pull at palm fronds, swing through the air, wrestle with Gremlin, and toss sticks into the air. Of course Fifi didn’t seem to worry about the mess of leaves and broken sticks Freud left on the forest floor. She would sit with Gremlin’s mother, Melissa, and they’d peacefully groom each other as Freud carried on his exuberant play. In times of danger, such as when a male baboon approached, Fifi would grab him securely and guide him away, but she seemed to accept that Freud was going to be his curious self, whether climbing, swinging from dangling branches, or chasing other chimpanzees his own age.

  Having witnessed Freud’s antics, I felt comfortable listening to Ellen describe her feeling of a lack of control in her life, though I certainly empathized more after my first son turned two! But knowing how natural all these wild instincts were and why they may have evolved helped me feel better grounded in my role as a family doctor dealing with behavioral issues. Even just watching the National Geographic films of two- and three-year-old chimps playing tag with each other or wrestling on the ground highlighted the need for this rough-and-tumble play as a part of their early development. From their play, these little primates learn how to fit into their community and communicate with their peers.

  I wonder, in fact, if suppressing too much of this lively exploring early in life might result in later problems such as depression, anxiety, or even aggression. Most humans have the skills later in life to temper their excitement and aggression, but young children don’t. Though boundary setting is crucial at various stages of human development—and it varies with each child—from chimpanzees I learned the benefits of giving plenty of space for exploration and experimentation in the early years. During this time, children are using their senses to discover how things work. They do this by touching, feeling, and watching, and incorporating this learning into their real and make-believe worlds. Their brains make connections to help them prosper in a complex environment.

  Though Ellen was well-read and progressive in her child-rearing, I wasn’t quite ready to say to her, “You know, Sam really reminds me of a wild chimpanzee named Freud.” Instead, I offered suggestions that seemed to help Ellen feel more accepting of her “wild” son based on my eight months of watching Fifi and Freud interact. What’s true for chimps isn’t always true for humans, but some of the basic, raw principles may apply. The idea of creating an “indestructible” and safe area in her house where Sam could let loose and explore in his own way was attractive to Ellen. I also said, “Just visualize Sam as an energetic, creative primate. He’ll need redirection at times, yes, but also room for adventure and space to build a strong, coordinated body.”

  Because of my work with both chimps and human infants, I often see similarities between our species. Every age in a human child’s life is important, but especially the early formative years. The bonds children form with their parents, grandparents, and guardians have a great impact on them. When Tommy was just five, I injured my spine playing soccer, and for two years didn’t have the physical ability or energy to play sports with him. More important, I didn’t have the focus to be as present a
nd as interactive as I’d have liked. Though my wife filled in for much of what I couldn’t do, I still look back at that time with regret because I wasn’t able to maintain the close bond I’d had with Tommy prior to my injury.

  With the chimp community, if the mother is injured or ill, there’s usually no replacement. On occasion, however, an older sibling or unrelated adolescent or adult may be equipped with skills and available to help out. When Gremlin gave birth to her twins, Golden and Glitter, their older sibling, Gaia, helped her mother care for them.

  In my practice I saw a young mother who was diagnosed with stage 4 colon cancer and had four young children to care for. During the last year of her life, she continued to be an attentive mom despite the physical pain of the cancer and the emotional pain of knowing that her children and husband were going to lose her.

  “Deb has been amazingly involved with the kids, even from bed,” her husband Dave informed me. “Sometimes I think she is a lot stronger than I would ever be, keeping up her parenting while dealing with the pain and nausea she is experiencing. She says I am the strong one, as I will now be a single parent without her.” Such purpose in both chimps and humans seems to trump everything else in these successful mothers.

  In the chimp community, just as with humans, the long period of infant dependency is crucial to developing the social and survival skills needed to succeed in their environment. Until the end, Fifi provided the right combination of support and playfulness to allow her offspring to become extremely competent adults. I can still picture her patiently waiting for Freud to practice his termiting skills. After snagging a large number of the tasty critters herself, Fifi seemed ready to move on, but she stayed there and allowed Freud to continue poking his stick at a termite mound, trying to learn the complicated skill. In a year or two, he would be able to extract the high-protein food on his own. Luckily, nursing offspring for up to five years allows chimp mothers to give each infant the intimate time being close to her it needs to learn these crucial skills.

  The obviously playful and joyful interactions of Flo and Fifi with their offspring seemed to result in their next generation’s being socially comfortable adults. As with humans and the nurture-versus-nature debate, it might be difficult to tease out how much of this resultant behavior is due to genetics and how much to parenting styles, but even early studies of primates point out crucial elements such as close contact and support early on as at least partially contributing to later emotional health.

  Flo faltered somewhat in the maternal care of her last two offspring, likely because of her advanced age and fragility, resulting in a very dependent youngster, Flint. When Flo’s next offspring, Flame, died at an early age, Flint became even more dependent on Flo and seemed to regress to fill Flame’s infantile position. Flint never progressed toward independence, as Flo was too weak to fend off his demands to sleep with her, nurse, and ride on her back, even when he was eight years old. His eventual death three weeks after his mother’s death resulted from his depressed, emaciated state and illustrates the sophisticated and challenging parenting required of chimp mothers to ensure the emotional growth as well as the healthy physical development of their offspring. Fifi and Flo didn’t have the support needed to help in the care of their offspring toward the end of their lives, even as they weakened. Because chimp mothers are very protective of their young, both Flo and Fifi likely would not have accepted another chimp’s help with mothering. Their lives ended with an eight-year-old (for Flo) and two-year-old (for Fifi) still dependent on them physically and emotionally. Neither offspring was able to survive without his mother.

  In my medical practice, I’ve seen impatience, neglect, and very tight controls in parenting situations. Sometimes I get a sense of mothering skills from descriptions of events at home. However, I also often get specific questions from parents that bring to mind Fifi’s successful mothering in the wild, and Melissa’s too.

  Early in my practice, the mother of a five-month-old said, “My friend was saying that holding and rocking my daughter a lot might spoil her.” I looked at her, and she was very lovingly holding the baby, but there was worry in her eyes. I thought back to my observations of the nursing and close body contact of young chimps and their mothers from sunrise to sunset, behaviors that extend for four to five years in the wild. This nurturing creates bonds that last a lifetime.

  “Don’t worry,” I told the new mother. “You’re forming a lifelong bond during these close times you share with your baby.” She smiled and looked down at the infant in her arms. I added, “Enjoy this time! Hold her, feed her, rock her, and enjoy the closeness you share. Don’t worry about spoiling her for another year—or more!”

  That new mom also joined a parent support group in her neighborhood, which helped her immensely, especially having the alliance of other mothers who were going through similar struggles and joys with their infants. The chimpanzee females got to witness other mothers nurturing their young in the course of everyday life, but humans often need to more explicitly seek out support and information.

  Some mothers and fathers in my practice have had difficulty nurturing their children due to stresses and distractions in their lives, such as working long hours outside the home, health problems like depression or anxiety, or simply not knowing how to parent after having had alcoholic or nonnurturing parents of their own. A distant or rigid form of parenting also seems to lead to major problems in children, who cannot adapt to that lack of warmth and nurturance along the way.

  With all the complexities of modern society, social customs, and family expectations, I’ve found it instructive to pay close attention to nurturing, patience, and bonds between the primary caretaker—whether mom, dad, aunt, or nanny—and the children, as these were crucial parenting attributes in the chimp community I studied. Though Seattle and an East African forest are very different settings for raising young primates, I came to understand that some of the basic mothering behaviors of the chimps I’d observed made sense for human childhood development too.

  CHAPTER ELEVEN

  FOREST REFLECTIONS: JUNGLE INFLUENCES IN MY PRACTICE

  What a privilege to be sitting next to a patient who trusts you enough to reveal their hidden fears and parts of their lives no one else might know about. The close connections I felt with my patients over the years kept me energized and enthused, and each patient encounter was like a new chapter in a novel.

  Because of the adult male and female chimps I studied, I often tried to understand my patients’ depression, anxiety, and aggressive behaviors from an evolutionary perspective. I would think about each person’s actions and reactions in light of how evolution has hardwired us to survive. This has been crucial in my understanding and planning of treatment for patients with ADHD, anxiety, anger management issues, and stress-induced conditions such as chronic headaches and intestinal disturbances.

  My time watching life and death among the chimps also prepared me to be an engaged listener. I could witness my patients as they struggled with the same joys and losses as any other species. When I watched my teenage patients lose the tight parental bonds formed in childhood and gradually enter the adult world, I remembered observing mirrored tension in the chimp community when Goblin and Pom began to seek their independence from their mothers. For example, Goblin would engage in tense interactions with alpha male Figan, followed by equally intense reassuring embraces with his mother, Melissa, clearly showing the emotional struggle churning within the preteen chimp. And Freud’s and Gremlin’s joy and laughter were not much different than the giggles and play wrestling of my sons and youngsters in my exam rooms. My time with the chimps trained me to look at the very basic needs that we humans have, such as reassurance through touch, having a purpose, and a connection to community, and not to underestimate the importance of those needs. I learned to slow down and offer my presence instead of a quick fix. In thinking about what is crucial for a healthy, developing forest chimp, I’m able to intuit what is missing in the lives of
the children and adults I see every day in the office.

  Some chimps and some people stand out in my mind as examples of how similar humans’ basic needs, behaviors, and social structures are to those of wild chimpanzees. As I continually review what Gombe taught me, I keep case notes on certain patients. This helps me make new and ongoing connections between what I learned as a young researcher and my evolving work as a family practitioner.

  Kumi and Community

  In Gombe I forged lifelong ideas about community. Living and working with others in that environment showed me what it means to be relied upon as well as what it means to rely on others. Taking turns shopping for food, supporting each other during injury and illness, and watching out for one another during adventures deepened my sense of how vital social connections are to anyone’s well-being. In family medicine, our training included assessing the social and psychological aspects of each patient in relation to the specific medical symptoms or chronic disease we are treating. A year after returning from Africa and starting medical school, I learned about the importance of these connections firsthand.

  In the summer of 1975, with a $1,000 grant provided by Case Western School of Medicine, I joined three other medical students in a cross-cultural study of health beliefs and practices in the United States. I chose Japanese-American families in the San Francisco area and interviewed first- and second-generation families about their traditional and Western views of health care.

  A Buddhist priest helped me find potential participants. I loved hearing family members describe their traditional remedies for various illnesses, such as drinking aloe vera mixtures for stomach problems and using moxibustion, a heat treatment, for back pain. Many also combined Western medical care with these more natural healing methods they learned growing up.