Today, we live in a technological society where much of our communication is virtual. Our society is more socially fragmented than it has ever been, with high divorce rates, disconnected suburban communities, and a lack of common values or even cultural rituals that keep us closely tied. In my private psychotherapy practice many of my clients have spoken of these issues over the years, and it is due to their distress that I decided to offer house calls as an optional service, if appropriate.

For issues such as parenting and child development, house calls may be the preferred method. There are several reasons for this:
1) Working directly with clients in their homes allows the therapist to provide “on the job training”, that is, the therapist can work more directly and experientially with the client.
2) The client often feels more comfortable and natural at home, and can be more authentic with the therapist.
3) The therapist can often see more family patterns, dynamics and challenges in the client’s home than in the office, and can utilize these insights in their work together.
4) Parents of young children often feel isolated, and the therapist visiting the family at home is experienced as the community reaching out to them.
5) Many parents are unable to find a babysitter for weekly office sessions, or can’t afford a babysitter, or both – and house calls can be a great service to them.

House calls can also be helpful for mothers with postpartum depression who find it difficult to get to a therapy session in the office. Oftentimes, these mothers don’t get the help they need because they feel helpless and isolated at home, and don’t know where to turn for support.

Psychotherapy is fairly new to society. Freud brought psychoanalysis to the world stage in the late nineteenth century, and since then, the role of the psychotherapist has gone through a number of metamorphoses. Freud’s psychoanalysis creates a psychic space for the client, and requires the therapist to act as a blank slate. And although this method is certainly effective in many cases, it may not always be so. For instance, when it comes to the issue of building secure attachments between parent and child, and developing stronger relational skills, the therapist as blank slate may not be very beneficial.

The role of healer changes throughout the centuries with the needs and conditions of the times. In Freud’s time, during the Victorian era, people were largely repressed, and did not have an awareness of their emotions. Though bringing awareness to our emotions is an ongoing and necessary focus of work, the role of healer may require another shift to meet the needs of people and families today.

New research in neuroscience reveals the importance of forming secure attachments in childhood, and that our interactions with others actually sculpt our brains and psychological development (Siegel, p.102). In light of the fragmented conditions in our culture today, combined with the pioneering new research in neuroscience, the role of healer may need to adjust again. Today’s psychotherapist will need to be mindful of the ways in which people’s brains develop, and have an understanding of how to facilitate the development of secure attachments and strong relational skills with their clients.

Because most families today don’t live near their extended family, they do not have the benefit of receiving help from their parents, grandparents, siblings or cousins in caring for their children. This lack of social connection and support leaves a number of gaps in the family system, often resulting in a great amount of pressure on the nuclear family unit. Humans evolved as interdependent, social beings, and we have not changed biologically in this regard. A therapist can help to fill some of these gaps left by modern changes in our culture by joining with the family and helping them to develop stronger attachments that will endure for generations to come.

House calls are not appropriate for all clients or issues, however. For example, when a client has experienced a trauma, or requires secure boundaries from the therapist, it would be in the client’s best interest to meet the therapist in their office. It is important to talk to your therapist about your specific issues and needs before you both decide upon the method of therapy and the location of the session that will be best for you.

The role of healer in society began as a medicine man or woman who was a member of the tribe, who was integrated into the community – and has transformed over the centuries into the role of priest, or doctor. The latest incarnation of the healer, the psychotherapist, has largely remained hidden behind a blank slate for the past century, a la Freud, and has generally not integrated into the community. But perhaps now, into the community is exactly where therapists need to go, when appropriate, to help children and families more directly, and to become agents of social change. Perhaps what was old is new again.

Reference
(D.J. Siegel, Parenting from the Inside Out, New York: Penguin, 2003)

Outliers: The Story of Success, by Malcolm Gladwell, looks at the possibility of a secondary road to success. “It is not the brightest who succeed,” writes Gladwell, “Nor is success simply the sum of the decisions and efforts we make on our own behalf. It is, rather, a gift. Outliers are those who have been given opportunities — and who have had the strength and presence of mind to seize them.”

Gladwell tells a story about the town of Bangor, Pennsylvania, where a community of southern Italians from the city of Roseto immigrated in 1882. They created a culture over time, that by the 1950’s, was found to be given to long life expectancies, about 30 to 35% above the average of other American cities. A doctor named Stewart Wolf set out to research and discover why this was. He attempted to find out why in this town “There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn’t have anyone on welfare. ” Wolf says, “These people were dying of old age. That’s it.”

Wolf finally realized that the health and happiness of this town of Rosetans was not due to diet, exercise or genetics. But that the secret to it’s longevity lay in the town itself. Gladwell writes, “They looked at how the Rosetans visited each other, stopping to chat with each other in Italian on the street, or cooking for each other in their backyards. They learned about the extended family clans that underlay the town’s social structure. They saw how many homes had three generations living under one roof, and how much respect grandparents commanded.”

Gladwell’s story speaks to the importance of being socially sustainable. Between the lines we can infer that the town’s health can be traced to it’s social intelligence, to it’s awareness of the importance of the whole, to it’s inclusive community, and interdependent culture. Gladwell looks not only at the specific scientific findings, but at all the parts, at the entire contex – and in so doing, discovers unexpected answers to our questions regarding health, happiness and success.

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To read more about Social Intelligence see www.danielgoleman.info/blog/

To read more about Malcom Gladwell’s book Outliers: The Story of Success, see Outliers on Amazon.com

Below is an excerpt from Malcom Gladwell’s new book, Outliers.

Roseto Valfortore lies one hundred miles southeast of Rome, in the Apennine foothills of the Italian province of Foggia. In the style of medieval villages, the town is organized around a large central square. Facing the square is the Palazzo Marchesale, the palace of the Saggese family, once the great landowner of those parts. An archway to one side leads to a church, the Madonna del Carmine — Our Lady of Mount Carmine. Narrow stone steps run up the hillside, flanked by closely-clustered two-story stone houses with red tile roofs.

For centuries, the paesani of Roseto worked in the marble quarries in the surrounding hills, or cultivated the fields in the terraced valley below, walking four and five miles down the mountain in the morning and then making the long journey back up the hill at night. It was a hard life. The townsfolk were barely literate and desperately poor and without much hope for economic betterment — until word reached Roseto at the end of the nineteenth century of the land of opportunity across the ocean.

In January of 1882, a group of eleven Rosetans — ten men and one boy — set sail for New York. They spent their first night in America sleeping on the floor of a tavern on Mulberry Street, in Manhattan’s Little Italy. Then they ventured west, ending up finding jobs in a slate quarry ninety miles west of the city in Bangor, Pennsylvania. The following year, fifteen Rosetans left Italy for America, and several members of that group ended up in Bangor as well, joining their compatriots in the slate quarry. Those immigrants, in turn, sent word back to Roseto about the promise of the New World, and soon one group of Rosetans after another packed up their bags and headed for Pennsylvania, until the initial stream of immigrants became a flood. In 1894 alone, some twelve hundred Rosetans applied for passports to America, leaving entire streets of their old village abandoned.

The Rosetans began buying land on a rocky hillside, connected to Bangor only by a steep, rutted wagon path. They built closely clustered two story stone houses, with slate roofs, on narrow streets running up and down the hillside. They built a church and called it Our Lady of Mount Carmel, and named the main street on which it stood Garibaldi Avenue, after the great hero of Italian unification. In the beginning, they called their town New Italy. But they soon changed it to something that seemed more appropriate, given that in the previous decade almost all of them had come from the same village in Italy. They called it Roseto.

In 1896, a dynamic young priest — Father Pasquale de Nisco — took over at Our Lady of Mount Carmel. De Nisco set up spiritual societies and organized festivals. He encouraged the townsfolk to clear the land, and plant onions, beans, potatoes, melons and fruit trees in the long backyards behind their houses. He gave out seeds and bulbs. The town came to life. The Rosetans began raising pigs in their backyard, and growing grapes for homemade wine. Schools, a park, a convent and a cemetery were built. Small shops and bakeries and restaurants and bars opened along Garibaldi Avenue. More than a dozen factories sprang up, making blouses for the garment trade. Neighboring Bangor was largely Welsh and English, and the next town over was overwhelmingly German, which meant — given the fractious relationships between the English and Germans and Italians, in those years — that Roseto stayed strictly for Rosetans: if you wandered up and down the streets of Roseto in Pennsylvania, in the first few decades after 1900, you would have heard only Italian spoken, and not just any Italian but the precise southern, Foggian dialect spoken back in the Italian Roseto. Roseto Pennsylvania was its own tiny, self-sufficient world — all but unknown by the society around it — and may well have remained so but for a man named Stewart Wolf.

Wolf was a physician. He studied digestion and the stomach, and taught in the medical school at the University of Oklahoma. He spent summers at a farm he’d bought in Pennsylvania. His house was not far from Roseto — but that, of course, didn’t mean much since Roseto was so much in its own world that you could live one town over and never know much about it. “One of the times when we were up there for the summer — this would have been in the late 1950’s, I was invited to give a talk at the local medical society,” Wolf said, years later, in an interview. “After the talk was over, one of the local doctors invited me to have a beer. And while we were having a drink he said, ‘You know, I’ve been practicing for seventeen years. I get patients from all over, and I rarely find anyone from Roseto under the age of sixty-five with heart disease.’”

Wolf was skeptical. This was the 1950’s, years before the advent of cholesterol lowering drugs, and aggressive prevention of heart disease. Heart attacks were an epidemic in the United States. They were the leading cause of death in men under the age of sixty-five. It was impossible to be a doctor, common sense said, and not see heart disease. But Wolf was also a man of deep curiosity. If somebody said that there were no heart attacks in Roseto, he wanted to find out whether that was true.

Wolf approached the mayor of Roseto and told him that his town represented a medical mystery. He enlisted the support of some of his students and colleagues from Oklahoma. They pored over the death certificates from residents of the town, going back as many years as they could. They analyzed physicians’ records. They took medical histories, and constructed family genealogies. “We got busy,” Wolf said. “We decided to do a preliminary study. We started in 1961. The mayor said — all my sisters are going to help you. He had four sisters. He said, ‘You can have the town council room.’ I said, ‘Where are you going to have council meetings?’ He said, ‘Well, we’ll postpone them for a while.’ The ladies would bring us lunch. We had little booths, where we could take blood, do EKGs. We were there for four weeks. Then I talked with the authorities. They gave us the school for the summer. We invited the entire population of Roseto to be tested.”

The results were astonishing. In Roseto, virtually no one under 55 died of a heart attack, or showed any signs of heart disease. For men over 65, the death rate from heart disease in Roseto was roughly half that of the United States as a whole. The death rate from all causes in Roseto, in fact, was something like thirty or thirty-five percent lower than it should have been.

Wolf brought in a friend of his, a sociologist from Oklahoma named John Bruhn, to help him. “I hired medical students and sociology grad students as interviewers, and in Roseto we went house to house and talked to every person aged twenty one and over,” Bruhn remembers. This had happened more than fifty years ago but Bruhn still had a sense of amazement in his voice as he remembered what they found. “There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn’t have anyone on welfare. Then we looked at peptic ulcers. They didn’t have any of those either. These people were dying of old age. That’s it.”

Wolf’s profession had a name for a place like Roseto — a place that lay outside everyday experience, where the normal rules did not apply. Roseto was an outlier.

Wolf’s first thought was that the Rosetans must have held on to some dietary practices from the old world that left them healthier than other Americans. But he quickly realized that wasn’t true. The Rosetans were cooking with lard, instead of the much healthier olive oil they used back in Italy. Pizza in Italy was a thin crust with salt, oil, and perhaps some tomatoes, anchovies or onions. Pizza in Pennsylvania was bread dough plus sausage, pepperoni, salami, ham and sometimes eggs. Sweets like biscotti and taralli used to be reserved for Christmas and Easter; now they were eaten all year round. When Wolf had dieticians analyze the typical Rosetan’s eating habits, he found that a whopping 41 percent of their calories came from fat. Nor was this a town where people got up at dawn to do yoga and run a brisk six miles. The Pennsylvanian Rosetans smoked heavily, and many were struggling with obesity.

If it wasn’t diet and exercise, then, what about genetics? The Rosetans were a close knit group, from the same region of Italy, and Wolf next thought was whether they were of a particularly hardy stock that protected them from disease. So he tracked down relatives of the Rosetans who were living in other parts of the United States, to see if they shared the same remarkable good health as their cousins in Pennsylvania. They didn’t.

He then looked at the region where the Rosetans lived. Was it possible that there was something about living in the foothills of Eastern Pennsylvania that was good for your health? The two closest towns to Roseto were Bangor, which was just down the hill, and Nazareth, a few miles away. These were both about the same size as Roseto, and populated with the same kind of hard-working European immigrants. Wolf combed through both towns’ medical records. For men over 65, the death rates from heart disease in Nazareth and Bangor were something like three times that of Roseto. Another dead end.

What Wolf slowly realized was that the secret of Roseto wasn’t diet or exercise or genes or the region where Roseto was situated. It had to be the Roseto itself. As Bruhn and Wolf walked around the town, they began to realize why. They looked at how the Rosetans visited each other, stopping to chat with each other in Italian on the street, or cooking for each other in their backyards. They learned about the extended family clans that underlay the town’s social structure. They saw how many homes had three generations living under one roof, and how much respect grandparents commanded. They went to Mass at Our Lady of Mt. Carmel Church and saw the unifying and calming effect of the church. They counted twenty-two separate civic organizations in a town of just under 2000 people. They picked up on the particular egalitarian ethos of the town, that discouraged the wealthy from flaunting their success and helped the unsuccessful obscure their failures.

In transplanting the paesani culture of southern Italy to the hills of eastern Pennsylvania the Rosetans had created a powerful, protective social structure capable of insulating them from the pressures of the modern world. The Rosetans were healthy because of where they were from, because of the world they had created for themselves in their tiny little town in the hills.

“I remember going to Roseto for the first time, and you’d see three generational family meals, all the bakeries, the people walking up and down the street, sitting on their porches talking to each other, the blouse mills where the women worked during the day, while the men worked in the slate quarries,” Bruhn said. “It was magical.”

When Bruhn and Wolf first presented their findings to the medical community, you can imagine the kind of skepticism they faced. They went to conferences, where their peers were presenting long rows of data, arrayed in complex charts, and referring to this kind of gene or that kind of physiological process, and they talked instead about the mysterious and magical benefits of people stopping to talk to each other on the street and having three generations living under one roof. Living a long life, the conventional wisdom said at the time, depended to a great extent on who we were — that is, our genes. It depended on the decisions people made — on what they chose to eat, and how much they chose to exercise, and how effectively they were treated by the medical system. No one was used to thinking about health in terms of a place.

Wolf and Bruhn had to convince the medical establishment to think about health and heart attacks in an entirely new way: they had to get them to realize that you couldn’t understand why someone was healthy if all you did was think about their individual choices or actions in isolation. You had to look beyond the individual. You had to understand what culture they were a part of, and who their friends and families were, and what town in Italy their family came from. You had to appreciate the idea that community — the values of the world we inhabit and the people we surround ourselves with — has a profound effect on who we are. The value of an outlier was that it forced you to look a little harder and dig little deeper than you normally would to make sense of the world. And if you did, you could learn something from the outlier than could use to help everyone else.




Helen Fisher is an anthropologist who has studied and written about the evolution of romantic love. Her books include The Anatomy of Love and Why We Love. In the TED presentation video below, she tells us that love has evolved over millenium via three primary brain systems and functions: the sex drive, romantic love, and attachment to a long term partner. All of these systems are intricately intertwined, and work together to enable humans to form romantic relationships.

Fisher also speaks of a new form of marriage that is now evolving. She calls it the symmetrical marriage, or the peer marriage, or the compatible marriage. This new form of marriage brings us to a new level of equality in the 21st century. This compatible marriage leads us back to the past, to an ancient spirit, to an earlier period in human history when most cultures were more tribal, more interdependent. This, however, is a new, higher and more complex version of the culture of our ancestors. It is my understanding that Helen Fisher’s scientific findings coordinate with the elements of Don Beck’s “second tier” in his theory of Spiral Dynamics, specifically the turquoise stage of development.

To read more about these topics see:

www.helenfisher.com

www.spiraldynamics.com

With social fragmentation so rampant today, I was deeply heartened by the writing of Isabel Allende in her memoir The Sum of Our Days. She tells us her story of fleeing Chile in 1975, after General Augusto Pinochet came into power and established an anti-communist dictatorship – and eventually making her way to California, where she was without social ties or old familial bonds. With courage and determination, she built and rebuilt, with great effort and love, a new “tribe”, as she calls it. Allende writes:

That was a period of many adjustments in the family’s relationships. I think that my need to create and hold together a family, more accurately, a small tribe, had been a part of me since my marriage when I was twenty years old, had grown stronger on leaving Chile – when my first husband and children reached Venezuela we had no friends or relatives except my parents, who had also sought asylum in Caracas – and was consolidated when I found myself an immigrant in the United States. Before I came into Willie’s life he had no idea what a family was; he lost his father when he was six, his mother retired into a private spiritual world to which he had no access, his first two marriages failed, and his children had very early set off on the path of drugs. At first, it was difficult for Willie to understand my obsession with gathering my children around me, to live as close to them as possible and to add others to that small base to form the large, united family I had always dreamed of. Willie considered it a romantic fantasy, impossible to carry out on the practical level, but in the years we’ve lived together not only has he realized that this is the way people live in most parts of the world, but also that he likes it. A tribe has it’s inconveniences, but also many advantages. I prefer it a thousand times to the American dream of absolute individual freedom, which, though it may help in getting ahead in this world, brings with it alienation and loneliness.

I found hope in Isabel Allende’s writing, as well as a way forward, that reveals an approach to healing fragmented lives; a way to start over and build a new life when the old one has crumbled.

“I don’t believe in that kind of math…..”

Swinging has always seemed like some strange foreign custom to me, like polygamy (one man having multiple wives) or polyandry (wife sharing) or bigamy (marrying another person while still being married to a second). But over the past couple of years I have been surprised at the number of people I have encountered who have told me various stories about swingers. You know, couples that swap partners. Most recently, I was made aware of a swinging circle at a local elementary school here in Mill Valley. The parents apparently rent a block of hotel rooms in San Francisco and exchange partners. I was also told a story of a married man with two children who attended a professional convention in San Francisco and was taken aback when a female VP invited him to attend a Karma Sutra party at her home, where the couples practice sexual positions and techniques openly in her living room. Even an old circle of friends have dabbled on the more innocent side of swinging, limited to kissing and dramatic play.

What is going on? I thought swingers went out in the 70’s with key parties and Barry White. Wasn’t this topic already brilliantly analyzed and illuminated in Ang Lee’s 1997 movie (based on the book by Rick Moody) The Ice Storm? The movie ends in tragedy, after two 1970’s suburban families from Connecticut experiment with swinging, affairs, and petty theft as ways to quell their existential anxiety, boredom and confusion.

I propose two main causes for the fashionable rise in swinging or affairs.

An Era of Decadence, a la The Roman Empire

The Fall of Rome was preceded by a period of decadence and moral disintegration. Decadence was not the cause of the fall, but it was a factor that contributed to the complex decline. The current decline in the United States has long been compared to the Fall of Rome, even if the particular commonalities are not exact. Morris Berman comments in his book The Twilight of American Culture, “Economic decline has an obvious “spiritual” component, which shows up as apathy and meaninglessness” (p.19). In Rome these attitudes revealed themselves as gladiators at the coliseum, copious indulgence in food and drink, orgies, wars, and general excess. In the United States they reveal themselves as mass consumerism, reality TV, wars, decreased literacy and education, and a $14 billion dollar porn industry.

With an increase in decadence often comes a decrease in connection to a sense of values and meaning. When people are disconnected from their deeper selves and from each other, when they feel alienated and empty and bored, when they can’t seem to find their place in the world, they often search for ways to fill the painful void with sex, drugs or alcohol, higher risks, novelty, excessive indulgences, and yes, swinging and affairs. Perhaps even if some people would like to experience a deeper connection to themselves and the world, they still may find themselves swept into the social tides of unconscious decadence, because this is what the tides of social structure push them to do. If people are psychologically and spiritually developed enough, they don’t need to depend upon the social structure to guide them, but unfortunately, many people are not fortunate enough to be so developed. Which leads me to the second cause.

A Relativistic Culture

A process of psychological development exists that spans well into adult life and permeates cultures around the world in similar ways, though often at different stages. In the United States, our current highest level of adult development (though a low percentage of the population have developed to even higher stages, but have little power as of yet) is expressed by a relativistic culture. These individuals are highly tolerant and accepting of differences, but the shadow side of that perception is a blind belief that everything is relative. There is no truth, no set of values, no traditions, no structure. Instead, they believe “to each his own.” And while these beliefs are humanistic and have brought equality to many of our social systems and laws, without any connection to a set of values that give us meaning, and without a structure of some sort that provides human relationships, families and societies with a sustainable practice, we are lost. We become fragmented internally and externally. We take ourselves too seriously, and in essence make choices only for ourselves, without considering the health of the whole. Swingers, being relativists, might say – if it makes me happy to swing, then there’s nothing wrong with it. I’ve heard people say that swinging enhances their marriage, that it makes it more exciting. But from a developmental standpoint, swinging actually does the opposite. It corrodes intimacy and trust. Relativists, or those seduced by decadence, are truly only filling the empty void that has formed within them. They feed the void with indulgences, but they will never be satisfied this way. Buddhists call trying to fill this void “hungry ghosts”. The ghosts are always and forever hungry, and will never be satiated.

Perhaps we should be honest about what kind of relationship we want. There are certainly many forms of relationships. If people want to have a relationship or marriage built upon chasing decadence and novelty and filling the void, they can have that. If they are relativists and want to believe that everything is relative, and that they need not take personal responsibility for their actions, then they can have that. But if they want to have a relationship or marriage built upon trust and intimacy that deepens and develops over time, then swinging is not an option. No matter how much our relativistic minds try to persuade us, and our indulgent selves try to convince us, it just doesn’t work.

The truth is, someone always gets hurt. Real pain always stems from these behaviors, whether immediately, or at some point in the future. To disregard this fact is ignorance, or wishful thinking, or just plain apathy disguised as liberation and acceptance

Below is a video from the movie The Ice Storm, which I highly recommend.

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okee-geo.jpg

Georgia O’Keeffe, 1918
Source: Encyclopaedia Britannica

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People sometimes ask me about the role that independence plays within the concept of social sustainability. They can at times confuse social sustainability with socialism, or with the idea that the community dominates and controls the individual. This is not the case.

When I speak of social sustainability I do not mean to reference communal cultures such as China, where the needs and desires of the individual are often not acknowledged or honored.

Instead, I believe it is important to integrate the roles of the individual and the community, as in the integration of opposites such as masculine and feminine, agency and communion, separation and individuation, interior and exterior.

There is a way to see a larger picture that includes all the myriad interactions within the whole system, and to then prioritize a plan of action. At times the action called for may require separation or independence. In other situations, the action called for may be self-surrender, or to place the needs of the community first.

These are not usually black and white situations or choices. Yet there are values and ethics involved that when contemplated, lead one to make the right decision for the moment and conditions.

One of my favorite independent role models is Georgia O’Keeffe. She charted her own territory in the vast desert regions of New Mexico, and lived largely in isolation with her paints and canvases. She was drawn to the dry, rugged landscapes of the area, and to the silence. “It suits me”, she said.

Does living in relative isolation mean one does not practice social sustainability? Not necessarily. Again, I believe the answer to that question depends upon the set of circumstances in ones life when one makes a decision to live in isolation. Georgia O’Keeffe, for instance, did not have children to care for. She and her husband, the photographer Alfred Stieglitz, had an understanding as artists that she would spend summers in New Mexico, knowing that solitude is an important function of the creative process, (even though he would have preferred her to stay in New York). Her husband passed away in 1946, when Georgia was 62 years old, and she moved to her ranch in the desert permanently three years later. Georgia also supported local farmers and workers, and preserved the land on which she had her ranch. She gave the world a great gift in the colorful, organic works of art she painted.

Consider another individual who wants to follow a similar course to that of Georgia O’Keeffe’s, but has a different set of life circumstances. This individual will have to contemplate making different life choices. Does this individual have children, a family, or people who depend upon him? Is he putting his needs above others when that is not what is called for in his situation? Will living in isolation benefit anyone else? How will he be contributing to his community and world? Exploring questions like these will help to clarify his choices and ultimate decision.

For a list of questions to consider if facing a big life transition or decision, see my Social Sustainability Questionnaire in the Essays section in the right side bar.

Below is a video of Georgia O’Keeffe being interviewed at her beloved Ghost Ranch in New Mexico.


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