Cooperation becomes a conscious activity in the fourth and fifth months of life, as babies begin to work with their mothers in breast feeding; the infant starts to respond to verbal cues about how it should behave, even if it does not understand the words, for instance responding to certain tones of voice by snuggling into position to help. Thanks to verbal cueing, anticipation enters the repertoire of the infant’s behaviour. By the second year of life infants become responsive to each other in a kindred way, anticipating each other’s movements. We now know that such cued behaviour – the stimulations of anticipating and responding – helps the brain activate previously dormant neural pathways, so that collaboration enables the human infant’s mental development.

The cues non-primate social animals give are static in the sense of being instantly readable; when bees ‘dance’ to each other they send precise signals, for instance, that pollen can be found 400 metres to the north-west; other bees know instantly how to read these cues. In infant human experience, cueing becomes increasingly un-beelike. The human infant tries out hand gestures, facial expressions, grips or touches which prove puzzling to adults rather than being instantly read and understood.

The psychologist Jerome Bruner has emphasized the importance of such enigmatic messages as signs of cognitive development. The infant increasingly intends a meaning on his or her own terms, as in crying. An infant crying at two months is simply reporting pain; in time, crying takes more varied forms because the infant is trying to say something more complicated, something the parent has more trouble interpreting. This gap is established by the second year of life, and changes the meaning of ‘mutual’; infant and adult continue to bond through give and take, but are not quite sure what they are exchanging, since the cueing process has become more complex. The gap between transmission and reception, Bruner says, constitutes a ‘new chapter’ in the bond between infant and parent. But the new chapter is not a disaster. Both infants and parents learn to adjust to it, indeed are stimulated by it to pay more attention to one another; communication has become more complex rather than broken down.

Still, for parents it’s easy to imagine babies have left the Garden of Eden when entering what Benjamin Spock famously called ‘the terrible twos’. The common explanation for a surfeit of anger at this stage is that the infant becomes surly as it separates physically from its mother. The child psychologists D. W. Winnicott and John Bowlby were the first to draw a more refined picture. In his studies, Winnicott built on the common parental observation that an infant, in working with the mother during breastfeeding, comes to recognize that the mother’s nipple is not part of his or her own body; Winnicott showed that the more freedom an infant is given to touch, lick and suck the nipple, the more aware he or she is of it as an outside, separated thing, belonging only to the mother. Bowlby made the same observation about tactile freedom in the child’s play after the second year of life; the more freely children interact with toys, the more they become aware of physical things as having an existence all their own. This physical awareness of separateness also appears in dealings with other children, in freely punching, kicking and licking them. It’s a discovery that other kids do not respond as the child expected, that others are separate beings.

Toddler life thus provides an early grounding in the experience of complexity and of difference. Children hardly ‘hibernate’ from each other, to invoke Robert Putnam’s image, as a result. If anything, separated and at cross purposes as they may be, they are ever more interactive. In this regard we want to put parents into the picture. On one account, parents who talk constantly to their babies produce two-year-olds who are more sociable with other infants, less anger-triggered against care-givers, than silent parents whose infants are more likely to be social isolates; the difference parental stimulation makes is detectable in greater or lesser activation of the infant’s neural circuits in the brain. But even if parental stimulation is inhibited, the baby’s physical drive to exchange cannot be extinguished. By the second year of life, all infants begin noticing and imitating what others do; learning about physical objects also speeds up, particularly about the size and weight of things, as well as their physical dangers. The social capacity to cooperate together on a common project, like building a snowman, becomes well established in toddlers by the third year of life: young children will do it, even if parental behaviour does not encourage it.

One virtue of understanding early experiences of cooperation as a rehearsal is that this concept explains how infants deal with frustration. Inability to communicate produces the frustration evinced by wailing, and trying out different wails is something infants learn to do – with a surprising result. Bowlby found infants are inclined to wail more as their vocal repertoire expands, since they now focus on, and are more curious about, the vocalization itself; they are no longer simply sending a sheer report of pain.

Equally important is the matter of structure and discipline. In a rehearsal, repetition provides a disciplining structure; you go over things again and again, seeking to make them better. Sheer mechanical repetitiveness is, to be sure, an element of play in childhood, just as hearing the same story over and over exactly in the same form is a pleasure. But mechanical repetition is only one element. Round about the age of four, children become capable of practising in the sense we understand it, either in playing a sport or a musical instrument; through repetition they try to get better at what they are doing.

Social consequences follow. In the nursery, Bowlby found, repetition begins to bond infants to one another when they experiment together and repeatedly; in performing a gesture together, the frustration of singing in coordinated time, for instance, becomes what he called a ‘transitional affect’, that is, no absolute bar to trying to get the coordination right the next time. Much other research has found that rehearsing, in the sense of working over a routine to improve it, is harder when done alone. Put more formally, repetition in time makes cooperation both sustainable and improvable.

The developmental origins of cooperation advance a further step by the age of four. Of course, sign-posting by years is arbitrary; development is elastic, varying from child to child. Still, by this age, the psychologist Erik Erikson has shown, young children become capable of studying their own behaviour reflexively, self-consciously, the act detachable from the self. In practical terms, he means that children have become more capable of self-criticism without the need of cueing or correction from parents or peers; when a child can do this, he or she has become, in Erikson’s framework, ‘individuated’. Around the age of five, children become avid revisionists, editing behaviour which has served them before but which no longer suffices.

Reflexive, self-critical thinking doesn’t imply withdrawal from other kids; children can be reflexive together. One piece of evidence Erikson provides for this process is game-playing. At the age of five to six, children begin to negotiate the rules for games, rather than, as at the age of two to three, take the rules as givens; the more negotiation occurs, the more strongly do children become bonded to one another in game-playing.

A century ago, in his study of play, Homo Ludens, the historian Johann Huizinga noted the difference between observing the rules of a game and discussing what these rules should be. To Huizinga, these seemed just alternatives children could choose at any time; modern psychology instead sees them as a sequence in the process of human development. As a recent study put it, sheer obedience comes first in the developmental process, the powers of negotiation later. A profound consequence ensues: development makes us capable of choosing the kind of cooperation we want, what its terms of exchange are, how we will cooperate. Freedom enters the experience of cooperation as a consequence.

Erikson’s sweeping point about this passage is that cooperation precedes individuation: cooperation is the foundation of human development, in that we learn how to be together before we learn how to stand apart. Erikson may seem to declare the obvious: we could not develop as individuals in isolation. Which means, though, that the very misunderstandings, separations, transitional objects and self-criticism which appear in the course of development are tests of how to relate to other people rather than how to hibernate; if the social bond is primary, its terms change up to the time children enter formal schooling.

From the book “Together: The Rituals, Pleasures, and Politics of Cooperation,” by Richard Sennett. Published by Yale University Press. Copyright © 2012 by Richard Sennett. Reprinted by permission of Yale University Press. Available wherever books are sold.

“Scared Sick: The Role of Childhood Trauma in Adult Disease,” the new book by Robin Karr-Morse and Meredith S. Wiley (respectively, a family therapist and a nonprofit worker with a background in family policy), explains just how profoundly babies and young children are affected by traumatic experiences. In the remarkably researched work, the two women show that early life malnutrition and abuse can affect a kid’s nervous system well into adulthood. Children raised in traumatic environments are more prone to cancer, chronic pain and even diabetes. The duo’s previous book, “Ghosts From the Nursery,” looked at the childhood roots of violence, but this new work is no less significant in its conclusions about American culture.

Salon spoke to Karr-Morse over the phone from Oregon about, among other things, trauma during pregnancy, its effect on later life — and what her findings mean for the future of America.

The subtitle of your book is “The Role of Childhood Trauma in Adult Disease.” What do you consider trauma?

A lot of people think of trauma as a physical occurrence, as big events: earthquakes or disasters, car accidents and so on. In the book, we are talking about emotional trauma very early in life — in the prenatal months and the first three years. We talk about what happens to a fetus and an early developing brain when there is chronic emotional trauma. In the case of the fetus, this trauma happens to the mother.

Central to this is something called the HPA axis, which is composed of the hypothalamus, the pituitary gland and the adrenal gland. What is it, and why does it matter?

There are two pieces of information that really provide the bridge to understand the connection between emotional trauma and adult disease, and the HPA axis is one of those pieces. The other is epigenetics. It starts with the hypothalamus in the brain, so that when we perceive any kind of threat to ourselves through the senses, through eyes or ears or nose or touch or whatever, that message comes into the brain and hits the hypothalamus. Then hypothalamus sends the message to the pituitary gland, which sits just below it, which in turn sends the message to the adrenal glands, which sit on top of each of the kidneys. This generates the flow of adrenaline and cortisol in the body. Adrenaline and cortisol are the hormones of stress. So there’s a connection between the hypothalamus, the pituitary, which is part of the endocrine system, and the adrenal gland, which is part of the immune system. That means that what happens to us emotionally affects our immune and endocrine functions.

When that happens early in life and chronically, it disregulates that whole system. “Trauma” means that stress is occurring over and over again chronically, so the HPA gets revved up and stays in the red zone. It upsets literally all of our physiology, activating the genetic proclivity we might have for whatever disease, setting the stage for it in the beginning, and oftentimes those systems don’t appear later in our lives until after our reproductive years. There is often a total disconnect between those diseases and its root in early chronic emotional trauma.

One of the ways children deal with trauma is that they simply freeze and become unresponsive. What is happening when that occurs?

Freeze is the signature of trauma. When we are upset, we go into fight/flight; the system is designed to enable our whole body to fight or flee. So our hearts pump, our breathing goes rapid and often shallow, our hands perspire, our stomachs tighten. Basically, our digestive systems stop and adrenaline shoots blood and enables oxygen to all of the limbs in the body to fight or flee, but if that happens over and over and over again, and you’re a baby and you can’t fight or flee, fight/flight becomes trauma or freeze state. It’s sort of like an electrical current, an outlet that is overwhelmed. The baby goes into freeze state, no longer crying, screaming, but rather sort of frozen and dissociated and removed from reality. It’s nature’s anesthesia to numb the brain and numb in preparation for death. But in a brand-new little nervous system, it doesn’t take a lot to put a baby into trauma or freeze state. With a brain that has developed normally and in a protected fashion, and then hits trauma later in life, we have one set of outcomes; but with a tiny baby, when this happens routinely, they can spend a great deal of time in frozen or dissociative trauma state.

So why is this trauma so much more significant when it happens to babies or young children than for adults?

That’s a really good question. The answer is that it’s in this prenatal period and in the first two to three years that the brain is developing structurally and chemically, so the whole rhythm of the brain, the chemical regulation of the brain, is set up then. If that little brain is set up with a great deal of trauma or chronic stress, the HPA axis is going to be activated chronically, and it truly disregulates everything. One of the things that they found out, for example, about post-traumatic stress was [in] soldiers returning from Afghanistan and Iraq: There’s a real difference in how people have experienced these violent scenes of blood and warfare. It appears as though there is a correlation between people who have come back with PTSD and early childhood trauma versus those who come back, obviously with terrible difficulties from having seen this, but not with post-traumatic stress.

And you use the metaphor of kindling to describe how this plays itself out.

It’s really not my term, that’s really Dr. Rob Scaer’s term, and I think he could explain it much more clearly than I can, but basically it’s the concept that the brain, once alerted or once becoming hypervigilant, tends to go into that trauma state much more quickly or tends to go into a reactivity or hypervigilance much more quickly. What early chronic exposure does is set the stage for the kindling process. It’s a way of describing the fact that a person who has had early chronic trauma is much more susceptible to later reactivity to stressful events.

What kind of traumas are we talking about when it comes to pregnancy?

There are two categories. One of them is hunger. If the mother is not getting adequate nutrition, the fetus may grow and form normally, but it will be compromised in terms of the number of cells in the various organs, so that the baby may be born at a low birth weight, fully formed and looking normal, but in reality the kidneys can have fewer nephrons, the heart can have fewer cells, and so on. So that it’s sort of like planned obsolescence when that individual reaches their reproductive years; their organs literally begin to fall apart, begin to wear much more quickly than organs that have been formed more fully. A second form is maternal stress, and that surprised us. We know that it’s common for women in pregnancy to be stressed, but to be extremely stressed chronically, where the mother’s HPA axis is already chronically on fight/flight, means that the baby is growing in an environment that is bathing in far too much cortisol. And that can have a tremendous influence on the nervous system of the fetus, so that baby, from birth, might be susceptible or hypervigilant or vulnerable to any form of stimulation, because their nervous system is set on high.

So what kind of things would trigger this in the mother? You mention poverty and war in the book.

Well ,you know, even in poverty and war, if she is part of a support system that anchors her or grounds her or protects her… but the studies have been done on women who have lived through concentration camps, have lived through violent histories with their partners, the children who have survived the Holocaust. Even the following generation can be still affected.

What kinds of traumas affect young children once they are born?

The research on this is prolific. A traumatic birth can certainly set off a series of problems: being born too soon, prematurity, and a stint in the NICU [neonatal intensive care unit]. Maternal depression is very profound, has a huge impact: as profound an impact as child abuse on that little brain. It can be caused by ongoing maternal neglect or family neglect. The attachment process early in life is really the hub, the core of that baby learning how to self-regulate its own nervous system. When it’s interrupted over and over again, as it is for infants who are left in various forms of childcare with neighbors, friends, catch as catch can, that’s a huge problem. So those are just a few examples from early in our lives that can set that little nervous system on high. One of them alone does not do this, and it’s terribly important that people realize that even when the mother is stressed, if things settle down, and the baby goes home with mom who moves into a more relaxed state and develops a strong stable environment for the baby and herself, that’s fine.

Prematurity, similarly, all by itself is a problem and it’s certainly associated with emotional and learning disabilities later, but that’s because so often prematurity accompanies or occurs in conjunction with issues like poverty and all kinds of stressors on the mom: drug abuse, mental illness, separation, single parenthood, teen parenthood and so on.

So what kinds of disease does this early trauma cause in people once they are grown?

Some of the really obvious ones are fibromyalgia and IBS, irritable bowel syndrome. Gut problems, chronic back pain, many forms of arthritis, cardiovascular issues, are probably the ones that occur to me first. Often times in chronic pain. Many of the subtler problems like fibromyalgia and many forms of chronic pain are diseases that doctors are flummoxed by. They don’t understand where the source of the problem is. It doesn’t appear to be genetic. The bridge to really understanding that is the adverse-childhood-experience study, the Felitti and Anda study that I mentioned in “Scared Sick,” that mentioned the histories of 58,000 Kaiser Permanente patients and correlated their middle-age health issues with the number of what they called adverse childhood experiences. It asked people specific questions like, “Was anyone in your family incarcerated in this period of time in your life?” It asks about child abuse, it asks about neglect, it asks about addiction, it asks about very specific issues early in life. And the correlations between the number of early childhood experiences and certain diseases is shocking. Cardiovascular being the glowing one, but some forms of cancer, some forms of arthritis, and as I say, gut and intestinal problems.

In the last few years, there’s been a big pushback against helicopter parenting. Is this an argument for or against that?

I kind of agree with the pushback against helicopter parenting. I spend my daytimes as a family therapist, working with people every day, with kids who are being thrown out of preschool for biting, kicking, hitting other kids, or who are having trouble learning for all kinds of reasons. That’s what I do for a living, and I work with families with children. We have many families in this country where the inmates are running the asylum: The children are running the family. And if children grow up thinking that they are the absolute center of the universe, and adults are abdicating their role of providing cortical-brain-based decent decision making and boundaries for kids, I do think that’s very troubling. But this is not what we are talking about here. We are talking about recognition of the fact that early in life, in pregnancy and early life for a child, we need a calm and balanced nervous system to guide and shape and build a calm and balanced nervous system in a baby. So I don’t see a conflict.

We also live in a modern society with a lot of advantages that humans in previous centuries and thousands of years did not. Children in the Stone Age were exposed to a tremendous amount of trauma on a daily basis. Doesn’t that suggest we should have evolved to deal with this by now?

They experienced stress for certain. Potentially trauma, yes. But the reality was that in place was a family, in place was a tribe, in place was a village that provided the stability and the regular protection of that little nervous system. A child might be traumatized by a saber-tooth tiger or whatever your fantasy is, but the familial system and the extended family were in place to pull that kid in. There was no, “Oh, that’s that person’s kid, I won’t touch them because I might get sued.” That provides some of the pieces of attachment that are so critical to building that little nervous system competently.

Given the sort of correlation between poverty and a higher incidence of potential trauma, this has real implications for the class system in the U.S. It shows how hard poverty works to keep itself alive.

That’s entirely correct. The reality is that we are a nation of idiots about infancy. We are the only postindustrial First World nation that hasn’t signed the U.N. rights of the child. We have a huge black eye in our nation regarding our rate of child abuse  and neglect. Our rate of incarceration is the greatest in the history of the world, and our childcare system in this country is deplorable still. It is simply not keeping up with the need. We have this wonderful catchphrase about leaving no child behind. Well, we’re leaving a lot of children behind.

It’s so much cheaper to build healthy kids than to fix broken adults. It’s so much cheaper in financial terms and more humane to attend to the front end, but we absolutely have huge pieces in place to keep that from happening. We have huge lobbies for the existing incarceration system, huge lobbies for the existing late-stage medical system, drug system, drug companies and so on. What can we do, really, that makes a difference? Certainly for ourselves there are some things to be done if we realize that trauma is at the root. There are some very different implications for adult health than we are currently practicing in Western medicine. If we recognize that that’s true for the babies we know about in this crazy world, there are some things that we can do that can set up our children and grandchildren for a very different future.

Two fundamental American ideals are that you can pull yourself out of any hardship no matter your background, and that whatever doesn’t kill us makes us stronger. Your findings go against this.

You are exactly right. What you need to understand first of all is that the human nervous system runs the world for better or for worse.  Genes do not explain the realities of the rates of disease we are seeing. The new information out of epigenetics, out of the Human Genome Project, is that DNA is only a part of a gene. Circulating around DNA are these proteins whose whole job is to sense the environment and then work with the DNA to express or repress pieces of DNA to enable that organism to survive the environment. So if the environment is stressful, or a mother is hungry, the epigenetic influences are profound from the very beginning of life. We are talking about issues like preserving the environment, and war, and health, but if our kids’ brains are disregulated from the beginning, we aren’t going to have that critical mass of people to think about and shape our future.

Even if their parents are still doing fine, middle-aged children need only look around at friends and neighbors to be reminded that these anxieties will become theirs one day. Indeed, most of the children I spoke with in the research for my book, “60 On Up: The Truth About Aging in America,” actively worry about their aging parents, often well before their parents need any help.

I see it with my own 63-year-old daughter, who wants me — her 87-year-old mother — to be in touch when I leave town, even if only for a few days or a week, who calls when she’s traveling though she never did before, whose anxiety announces itself over the phone lines when we haven’t talked for a while: “Are you OK?” I tell her I’m fine, ask her to stop worrying. “It’s my turn to worry,” she replies.

She and her husband have regularly spent some weeks each year in adventurous travel abroad. Now, she’s reluctant to go away for so long and resists going anyplace where she’ll be out of reach for more than a day or two. When I tell her that her anxieties are overblown, that her fears are unfounded, that I want her to go and enjoy herself, she looks at me and says, “It has nothing to do with what you want. It’s what I need.”

It’s a response that moves me to tears, while a little corner of my brain thinks, “Yes, I know, but that’s your problem. It has nothing to do with what I need right now.”

When she read these words in an earlier draft of this article, she called. “I think you left something out here, Mom.” I’m quiet, puzzled, waiting for the rest, until she goes on to remind me that when she phoned to say they were back after their last overseas trip, my immediate response was one of great relief — “as if,” she says, “you were holding your breath the whole time we were gone. You actually told me that you were relieved and that you didn’t really like it anymore when I’m so far away for so long.”

I resist at first, wanting to tell her she’s making more of it than I meant. Then I remember the rush of unshed tears when I heard her cheery, “We’re home!” at the other end of the phone line, remember, too, how comforted I felt to know she was nearby again, relieved of an anxiety I hadn’t even fully known was there.

“But I also meant it when I said I don’t want my feelings about this to determine how you live your life,” I say.

“I know,” she says, “but that’s only because you think you always have to be the mom. I love you for it, but it can be a pain when I feel like I’m getting mixed signals and when you try to protect me when I don’t need your protection.”

Another reader — the adult child of another mother — to whom I sent an earlier version of this article, sends an email pointing to this passage and says, “It would be nice if you’d expand on what you do need. Parents tend not to say what they need, and we children are left to try to figure it out, which leads to problems when we make mistakes.”

These issues between parents and children, the mixed messages on both sides — children who say they want to help but who already have too many demands on their time and energy, parents who say they don’t need anything but clearly do — are an old story. It’s not news either that adult children have always worried about their parents, that they’ve always cared for them in their old age, and that the role reversal is inevitably a wrenching emotional experience for all concerned.

But the demographic and cultural context in which this takes place is vastly different now than it was a century ago. Then, few women worked outside the home, so someone was available to care for an ailing parent. Today, a changed culture combined with economic need has put most women in the labor force alongside their men, which means that there’s no one at home to take care of Mom or Dad when they need it. Then, life expectancy at birth was just over 48 years; today, it’s close to 80. Then, so few lived to 65 that there is no record of life expectancy at that age. Today, if we make it to 65, we can expect to live another 20 years. And one-third of those over 65 need some help in managing their daily lives; by the time they reach 85 (the fastest-growing segment of our population today), that number jumps to well over one-half.

The result: Middle-aged adults may well spend more years caring for a parent than they did for their children.

Those in their 60s and 70s, who looked forward to these years with their promise of freedom from the responsibilities that bound them before, are now asking: “When do I get to live my life for myself?” The younger ones, who at middle age are already stretched thin by their own financial problems — worried about how they’ll provide for their children’s education, whether they’ll ever have enough for their own retirement, how they’ll live the rest of their lives — are asking: “How can I do it all?”

No one wants to ignore parental needs, but unless there are financial resources well beyond what most families can dream about, how to meet those needs is a problem with no easy solution. For the children, it can mean bringing their parents into their homes and, among other things, dealing with a spouse’s grumblings about the intrusion in their lives, teenagers’ complaints about giving up the privacy of their rooms and coming home to Grandma or Grandpa after school – a tempest that sometimes strains marriages to the breaking point.

If there’s one word to describe the dominant feeling on both sides of the bridge that connects the generations at this stage of life, it’s “ambivalence.” “I love my parents, but…” That’s a line I hear spoken repeatedly as women and men struggle with the duality of their feelings — their love for their parents; their sense of obligation; their guilt that, no matter how much they do, it never seems to be enough; their difficulty in coping with their own needs, with their jobs, their families, their fears about their future and, not least, the inability to see an end in sight. The parents’ stories are the mirror image of their children’s. “I love my children, I know they want to help, but…” The words say they appreciate their children’s concern while they feel it as an infringement on their autonomy.

Children grumble about how hard it is to reason with their parents, about how they resist any change even when it seems clearly necessary. Parents complain about unwelcome intrusions, about being talked to as if they were incompetent children. “It’s what happens when you’re old. You lose all credibility, and people treat you as if you’re half brain-dead,” observes an 86-year-old father heatedly. “It’s damn insulting, and I don’t like it any better when my children do it. Worst part of it is, they don’t get it. They just write you off as being difficult.”

His 79-year-old wife agrees but speaks with more understanding of the difficult situation in which they all find themselves, welcoming her daughter’s caring while also resenting her interference. “I know she doesn’t agree with our decision to stay in our house, but that’s only because she wants us someplace she thinks is safe, so she doesn’t have to worry.” She hesitates a moment as if considering whether to go on or not, then adds, “I don’t know exactly how to say this, but sometimes I think the kids are selfish, too. I mean, I know they love us and want the best for us, but is it an accident that what they think is best is what will relieve them, whether it’s really good for us or not?”

An accusation that’s not without some merit, but one also that doesn’t take account of the complex and conflicting feelings both generations juggle. Looked at from the parents’ side, there may, in fact, be something self-serving in the way children push parents to give up their home, their cars, their lives, so that they can stop worrying about them. Some even acknowledge it. But step into the children’s shoes, and you wonder: Who’s selfish? Is it selfish of parents to insist on maintaining their lives and the home of a past they can no longer live easily without considering the price children pay?

True, parents didn’t count the cost, whether financial or emotional, when they gave themselves over to caring for their children. But parents chose that life. It wasn’t forced on them by circumstances outside their control, and the legitimacy of their authority to do so was unquestioned. But taking care of Mom and Dad profoundly interrupts the lives of adult children who have no authority to control or manage the situation unless their parents willingly hand it over. “I feel like I’m being torn to pieces,” cries a 48-year-old woman as she struggles to balance her care and concern for her 70-something parents who need help and don’t have the financial resources to pay for it.

Her parents’ response: “We just want her to stop nagging us and let us live our lives the way we want to.” I remind them that their daughter says they can’t afford to continue to live their lives as they have.

“That’s our problem,” her mother replies, hotly. “We’ve managed until now. We’ll manage again.”

It’s a no-win situation. Parents commonly resist their children’s attempts to intervene, but they are often in denial about the depth of their decline and can’t or won’t see what’s plain to others: They need help. If children back off from the conflict, their parents can fall through the cracks. If they don’t, parents are often resentful and difficult. “They think because their father died, I need them to tell me how to run my life — where to live, how to spend my money. It’s ridiculous. I love them and I don’t want to get upset and argue with them, so I finally just stopped listening when they talk. Sometimes when I know it’s one of them calling, I don’t answer the phone.”

It’s an upside-down version of the familiar passive-aggressive drama between parent and adolescent child: “Where are you going?” “Out.” “Who are you going with?” “Nobody.” “What are you going to do?” “Nothing.” Just as parents must decide when to intervene and demand answers, so adult children sometimes have no choice but to take control.

“My mother is furious with me because I insisted on moving her into an assisted-living place,” says a 70-year-old man mournfully. Then, his sadness turning to anger, “For God’s sake, she’s 89 years old and has arthritis so bad she can hardly move. I don’t think she’ll ever forgive me, but when I found her on the floor because she fell and couldn’t get up, there was nothing else to do.”

There is no right and wrong here, no black and white; there are only shades of gray in situations so murky that it’s nearly impossible for either parents or children to know just when it’s the right time to take a step, make a move. Children, who think they see the line more clearly, push their parents to a decision, mostly out of loving concern but also because they need some relief from the worry and the burden. Parents fight more tenaciously to hold on to what’s left, as each step of their decline poses another threat to their sense of self. They tell themselves they’ll know when the time has come; then one day they slip, fall and can’t get up. Or at some unseen, unfelt moment, they slide past the time when they were mentally capable of making a reasoned choice. For a disease of the mind doesn’t arrive with the drama of a broken hip; it travels stealthily, taking little bits and pieces as it moves through the brain, each one seeming inconsequential in itself until one day the person has slipped over the edge.

What to do? I have no easy answers. What I do know is that one of the great challenges facing both the nation and its families is how to take care of our parents and grandparents — a problem that is increasing exponentially as 78 million baby boomers have begun to move into the ranks of the elderly. In an article last month in the New York Times about the failures of Medicare — what it does that it shouldn’t do, what it doesn’t do that it should — Jane Gross tallies some of the social cost: “Right now, there are 47 million Medicare beneficiaries, costing a half trillion dollars a year, or one-fifth of the nation’s health spending. In 2050, the population on Medicare will number 89 million. How scary is that?”

Scary enough to push us to lift our voices for some radical change in the way healthcare is delivered in our nation. I know, I know. We’re living in a moment when the rise of the political right, and the consequent gridlock in Washington, has even made it socially and politically acceptable to propose the abolition of Medicare and Social Security as we’ve known them. But that doesn’t mean we must suffer in silence. Rather, we — both parents and children — have to make ourselves heard on behalf of the kinds of changes that will lift some of the strain from the backs of both generations. At minimum, a change in Medicare policy that would allow for long-term care, whether outside or inside the home, without requiring that the recipient be impoverished — a policy shift that would ease the financial anxieties of both generations and surely assuage some of their psychological anxieties as well. At best, a national universal healthcare system that, like those in every other Western democracy, would ensure healthcare for all Americans and wouldn’t break the bank, as our present for-profit system threatens to do.

Meanwhile, take a deep breath and come to terms with the reality that our new longevity is both a blessing and a curse — a blessing because we live longer, healthier lives than we ever dreamed possible, a curse because old age sucks. It always has, and it always will, because it is, by definition, a period of decline that takes a toll on those who are old and those who love them. The only difference now is that, because we live so long, our children suffer it right alongside us.

“This was supposed to be my time,” says a 75-year-old retired widower whose 94-year-old mother has been living with him for 13 years. “It’s hard not to think, What about me? I’ve had some heart problems, and I think about that and know that, well, you know, I could die anytime and I’ll never have had the chance to live these years like I wanted to.”

Beforehand, I had my daughter every other weekend, overnights during the middle of the week, and I would have her stay with me for up to a week at a time when her mother would travel for work (which was four to six times a year). I have been consistently paying support without complaint.

That schedule changed to just every other weekend. And even though I was making more money, I was being called a “deadbeat.” And she was angry I took a job “without consulting her.” We were never married. Why should I have “consulted her”?

So she got a lawyer. And I had to get a lawyer. This caused a lot of stress since I was trying to work myself into a new job at the same time. Since being a paralegal at a new firm requires concentration, my performance wasn’t what it should’ve been.

The good thing about all of this is I have been with a wonderful woman for 18 months. She was the one who inspired me to get a better job in the first place. She is standing by me. But I don’t want this to go on for long. I have been seeing recruiters and actively job searching. But Christmas is coming and I don’t want my little girl to miss out. Nor do I want to disappoint my girlfriend.

In the end, I want to find a job, settle this child-support case and marry my girlfriend. But I’m afraid. I know it will turn out better in the end, but I want to get this over with as soon as possible.

I’ve had problems with anxiety and self-esteem and I’ve often felt isolated at workplaces. The firm where I worked for four years was low-paying, had a crappy environment and no future. I wanted better. But it was a little overwhelming and I didn’t want my personal life to become part of everyone’s else space.

Do I just keep trucking and not worry? I’ve been trying meditation and wish lists, and they’ve helped in general. But I just want to move forward to the next phase in life.

Trying to Move Forward

Dear Trying to Move Forward,

Your daughter’s mother’s reaction to your getting a new job without consulting her is interesting. You may feel she wants control, or veto power. But involving her in, or at least giving her advance notice of, decisions that affect the childcare arrangement is an excellent idea. When you don’t involve her, it increases her sense of mistrust and fear. When she receives surprise news, she is more likely to escalate because she feels powerless. If you keep her in the loop, she will feel less urgently compelled to attack.

Generally, if there is anything you can do to improve the relationship with your ex, I suggest you try. It’s a terrible drain to be fighting like this. It’s expensive, too, when lawyers get involved.

There may be certain things whose disclosure would put you at a disadvantage or expose you to harm. But where possible, keep her informed. Make an effort. Show her respect. It can only help.

When it hurts, remind yourself that you’re not really doing it for her. You’re doing it for your daughter, and for your future.

You may not see any immediate benefits. But keep at it. You two will be raising your daughter jointly for the next 15 years or so. That is a good reason to start now on a long-term effort to improve the emotional tenor of your relationship.

Your current girlfriend may well view such attempts with alarm. But try. Pay attention to the emotional side of it. Trying to ease the conflict will at least ease your conscience. Trying to do the right thing without thought for personal gain is great for self-esteem.

Progress in life is often slow. While slogging it out, stop and take stock. You have love in your life. You love your daughter and she loves you. You love your girlfriend and she loves you. You have skills that will land you another job soon. And you have plans to marry. These are all great things.

So keep doing the things that work. If meditation helps, keep doing it. Keep making your wish lists. Whatever works, keep it in your life. When frustration or low self-esteem tempt you to give up on some of these things, just do them anyway. Build strong habits. They will help you through tough times.

You’re going to be at this a long time. You’ll be in your mid-50s when your daughter is ready for college. So think long-term. Paradoxically, that means paying attention to the now. Think long-term but stay in the now.

If you get that, you’ll be fine.

Manipulation formed the heart of our relationship. Recently, I found an entry in my middle school diary: “Dear Journal, Guess what! Valerie Jones, the biggest nerd in school, has an uncle who owns a dance/dinner club. For her birthday, he’s letting her rent it and invite 100 friends! Since she has no friends, I get to make the invitation list! This is gonna be great!” (The party never took place.)

Valerie was naive and mild-mannered, more comfortable around adults than those her own age, and I enjoyed mocking her innocence. I invited her to join the “Pen 15 Club,” which involved writing the word “PENIS” on her hand in permanent marker. She was the only person who fell for it. Later, Valerie’s teacher pulled me into the hall. “How would you feel if I wrote ‘penis’ on your hand?” she asked me. Frankly, I’d be confused. Why would a grown woman write “penis” on my hand?

But Valerie wasn’t my only victim. Julia Ryan was pretty, blond and flirtatious; the boys loved her. Her house was across the street from mine, so we were close, but our relationship ran hot and cold. One big fight and, poof — we hated each other for the entire school year. But while she simply ignored me, I schemed up ways to humiliate her and bring others onto my side. I spread rumors. I kicked the back of her chair during band practice. I slammed her head against a locker in the hallway. One afternoon, on the bus home from school, I passed an empty plastic jar around and asked everyone to spit in it. Then, as the bus flew over bumps, I crept up behind Julia and poured the contents over her head.

Stories about bullying in grade school almost always appear from the perspective of the persecuted, and with good reason: It’s hard to admit you were once a total jerk. But what these pieces rarely talk about is how bullying someone else can haunt you, the persecutor. Eighteen years after it took place, I still wanted to know: How much damage did I inflict? And why did I do it in the first place?

Kids bully for many reasons. Sometimes they’re mirroring the aggressive behavior they see in their parents. And sometimes they’re going through problems at home, like divorce or financial issues. But I grew up in a traditional, “Leave It to Beaver”-style family, unmarred by domestic drama. Instead, my motivation derived from something just as ordinary: tremendous insecurity.

At 12 years old, I was tall and loud, with braces, acne and thin hair. Once, at a sleepover in seventh grade, I stumbled upon a notebook in which the host and others had graded every girl in our class on personality and attractiveness. I got a seven in personality — and a three in looks.

Another excerpt from my diary, just weeks after the entry about Valerie, read, “I’m constantly worrying about homework and looks and popularity and guys and grades and teachers and abilities and everything imaginable. I get so depressed sometimes. I feel like no one cares about me. They all just care about themselves.”

I thought I was the only person in the world who felt this way. It never occurred to me that the people I was picking on were probably thinking the same thing about themselves — as a result of my bullying. In fact, I never considered my victims’ feelings or private lives at all. They could’ve been stabbing voodoo dolls of my likeness nightly, for all I knew or cared. My experience was all that mattered.

In an effort to understand what could’ve possibly made me so self-absorbed as a kid, I called up Rachel Simmons, author of “Odd Girl Out: The Hidden Culture of Aggression in Girls.”

“Middle schoolers have epic empathy fail,” she explained. “It’s not because they’re bad people. There are plenty of bullies who grow up and realize the errors of their ways, but they need a level of self-reflection and accountability that not everyone has.”

At some point, around eighth or ninth grade, I stopped bullying. Instead, I fell in with a crowd of thespians who delighted in my brazenness. Now, at 30, the pain and confusion of middle school seem lifetimes away. But still, I couldn’t shake the guilt. So I set out to do something most bullies never do, especially not 18 years after the fact: apologize.

I reached out to Julia and Valerie on Facebook, keeping in mind how touchy this subject could be. No one likes to open old wounds, and I didn’t know these girls anymore or have any idea how they’d respond. The thought of them fearing or hating me all over again almost made me slam my laptop shut and scrap the whole thing.

Julia and I had made up in seventh grade and were already Facebook friends, so I kept my email casual: “I remember giving you a really hard time in sixth grade. I think it’s safe to say I bullied you. Do you have any memories of this?” I recalled the incident with the jar of spit on the bus. “I’d like to officially apologize. I’m really glad we were able to reconcile in seventh grade.”

It took Julia six days to respond, during which my mind ran amok: What if I touched a nerve, and she hates me now? What if she was so traumatized, she can’t bear to recall those memories? Am I still a horrible person?

As it turns out she was just busy and found my email hilarious: “I laughed out loud when I read this message!” she wrote. “So funny to think about childhood memories but, yes, we were really mean to one another at times.”

We? That was generous. I’m pretty sure I was the instigator 99 percent of the time. Julia offered up a different memory on the bus that involved me pressuring another kid into shoving her. “I’m sure my mom remembers that moment too because [when I got home] I was ready to go nuts,” she wrote. But she didn’t show a hint of bitterness or resentment in her words, and our exchange quickly evolved into did-you-hear-that-so-and-so-got-married pleasantry.

My interaction with Valerie, on the other hand, was more formal. We’d never become friends and I hadn’t seen her since high school. “I want to apologize for being so mean to you during our school days,” I wrote. “It’s only been through looking back as an adult that I realize I was a bully. I remember saying things to you and doing things that were cruel, and I wish I could take them all back. You never did a single thing to deserve being treated that way.”

She responded to my message immediately, with a friend request and written reply that read a bit like a form letter. “I hold no ill will towards you, or anyone else, for the things that were said or done to me during our school years,” she wrote. “All is forgiven.”

I asked to apologize verbally, so we set up a time to talk on the phone a week later — her in Des Moines, where she works as a daycare teacher, and me in Minneapolis, where I’m a magazine editor at a regional publishing company. My heart thudded as I dialed her number. I imagined her breaking down and sobbing, saying that I’d made her life hell and she’d needed years of reparative therapy. Or maybe she’d been waiting for this moment and was finally going to let me have it, barraging me with a string of curse words. Or, as one of my friends had joked, I was on the top of her “To Kill” list and this was my last chance to lift the death sentence.

She answered the phone, and we chatted amicably for a few minutes about our jobs and the schoolmates we’d kept in touch with over the years. Eventually, we ran out of things to say and there was an awkward pause as we both waited for me to bring up the reason for the phone call. I took a breath. “Valerie, do you remember me bullying you in middle school?”

“I really don’t,” she replied, her voice confident and mature. “I remember that things happened. I remember that things were probably said. But, however many years later, you just have to come to a point where you let it go.”

Valerie couldn’t (or perhaps chose not to) recall any interactions with me in school, but apparently I wasn’t her worst persecutor. She told me that a guy named Andy used to berate her daily during 10th grade choir class, whispering things like, “You suck” and “I hate you” across his music stand.

“Choir was my favorite part of the day, and it started affecting my love for music,” she said. “The choir director finally noticed and talked to the assistant principal, and Andy stopped for a little bit, but then he started back up again during junior year.”

Andy was an exception — the bulk of her bullying came from other girls, like me. “I was that kid that people picked on, for whatever reason,” she said. “I couldn’t tell you why specifically. In that environment, you’ve got the kids who are the mean ones or the bullies, and then you’ve got the ones who are easy targets. And I guess I was an easy target.”

Adults had told her to ignore her bullies and they’d go away, so she never stood up for herself. This tactic didn’t help. “Those words and the things that people said were very hurtful, you know?” she said. “As much as people can say, ‘Sticks and stone may break my bones, but words will never hurt me,’ well, I don’t really find that to be true. Now that years have passed, and I’ve gotten over it, I think that those kinds of things can have an effect on a person, even years later. I think it probably made me a stronger person.

As we neared the end of our phone call, I apologized again and told her, half-jokingly, that I was glad to hear I hadn’t ruined her life.

“No, you did not ruin my life. Not at all,” she said. “I totally forgive you. It’s in the past. I don’t think it’s healthy for either of us to hold on to that kind of stuff. Move forward and move on.”

We hung up, and I sat in silence for a while, letting her words reverberate.

Both of my victims seemed unfazed by my emails and phone call, yet here I was, still punishing myself. What was I holding on to? I’m 30 years old and my life is everything I’ve ever wanted it to be: I love my job. I have an amazing boyfriend and tons of friends (many of whom would be surprised to learn that I was once a bully). The acne that plagued me in middle school has since disappeared. My hair became thick and wavy in my 20s. And at 5-foot-10, I love being tall and wouldn’t have it any other way.

It’s become clear to me that confronting my victims has rattled my normally strong self-esteem. I’ve been forced to face the darkest part of my past — the insecure, spiteful little girl capable of hurting another person without thinking twice, the child who hates being tall and fears that she’s ugly — and only through talking it out and writing it down have I realized just how far I’ve come. That time in my life is ancient history, a brief, but potent chapter that’ll serve as a lesson for future offspring.

Valerie and Julia didn’t need my apology after all — they’d put the past to bed long ago. All I’d really needed to do, as it turns out, is forgive myself.