Myopia

Stacy, thirty-two, wants to travel world for a year and then decide how she wants to make a living. Her aunt Mo thinks she is making a horrible mistake. Stacy and Mo love each other, but now they cannot be in the same room. “She called me myopic,” Stacy says, bewildered.  “What does she think you should do?” I ask. “She thinks I should get a career path, get married and have kids. I want those things. I just don’t want them now.” Stacy says, with a sound of protest which resembles an adolescent. “It sounds like Mo hit a nerve,” I say, implying that she has some insecurities about her travel plans. “Well, yes, I am really not sure what I want to do with my life and so traveling postpones that decision for a year, but I don’t want to admit that to Mo.” Stacy says with candor and shame. “You don’t want to admit that to Mo because you want her to believe that you feel more confident than you actually do.” I say, pointing out her embarrassment over her uncertainties. “Yea, and I don’t want to tell her that she has a point.” Stacy says, as if she and Mo are at war. “Why can’t you tell her that you understand and appreciate her concern?” I say, pointing out that people who are interested in your welfare are hard to come by. “I have told her that, but I also think she should trust me that I will figure it out.” Stacy says, with the irony that she does not trust herself to “figure it out.” “You mean that her questioning your decision makes you feel that she has no faith in you?” I say, trying to show her that Stacy is projecting her insecurities on to Mo. “Yes, when she questions me, I question myself and I don’t like that feeling.” Stacy says, revealing that the problem with the question is that it makes her uncomfortable because it hits on unresolved issues for her. I repeat, “So Mo hit a nerve and now you are in pain.” “I guess so,” she agrees, but still confused about how to handle her relationship with Mo. “Maybe you can tell her that your life is uncertain, and that you can live with that and you hope she can too.” I suggest, hoping that an honesty about her internal state might be helpful. “I will try that,” Stacy agrees, with a hopeful tone.

Re-Posting Because of Today’s LA Times: Father Boyle

Today’s LA Times….http://www.latimes.com/news/opinion/commentary/la-oe-newton-column-homeboy-industries-greg-boyle-20120423,0,5754852.column

Father Gregory Boyle, a jesuit priest,http://www.npr.org/templates/story/story.php?storyId=3911907 , and http://latimesblogs.latimes.com/jacketcopy/2010/06/father-boyle-la-times-bestsellers.html reminds me of my earlier post  http://shirahvollmermd.wordpress.com/page/16/. Father Boyle knew intuitively that when gang members can find an alternative sense of belonging they can find a new way to be in the world. He proves, through his life’s work, the value of attachment. He invests emotional energy in “kids” who have never ”experienced dignity before.” By dignity, he means that when one begins to respect the individuality of these gang members, then the adolescent can change their lives and contribute to society. He gives them work skills and in so doing he proves to the ex-gang members that they have hope to make their lives better. In my mind, he re-parents these young adults such that these youngsters can “navigate the treacherous waters of their lives.” As Father Boyle says “people say I give them a second chance, but I say, it is really a first chance.” “Gang members are coming from a place of despair” he says. Without formal mental health training, Father Boyle recognizes the essential need to have a family that instills hope in the future. He teaches coping skills, parenting skills, and responsibility such that they can deal with the challenges of their world. His work inspires therapists to work on a one on one basis to change lives, by believing in their client, such that the client can eventually change course and live in the world in a new way. Inspiring.

Fathers Always Want Their Sons To Do Well: Not

“Footnote” describes the dynamics between fathers and sons, where the idealized version of a father who wants to see his son flourish is dismissed quickly. From the first scene, we see the bitterness and resentment that the father has for his successful son. On the one hand, why should this come as a surprise? As a species we tend to feel better when we perceive ourselves as “ahead” and we feel worse when we think we are “less than”. On the other hand, there is a notion that our children are extensions of us, and hence their accomplishment is a reflection on us, hence parents would be proud of the success in their children. Both are true and both are at play, in some measure,  all of the time.

This movie depicts the former scenario in which father and son are rivalrous, perhaps for the love of the wife/mother, as Freud might say. What was charming about this flawed movie was that it felt so real. The accomplishments of the son led to bitterness in the father which led the son to feel bad about himself. No one was happy. As long as they needed to please each other, there would be no joy or fulfillment. Their connection prohibited them from seeing outside of themselves, and hence they were stuck in a very negative place. There was no happy ending.

I would like to think that therapy would have helped all of them. Actually, I feel pretty sure that psychotherapy for any of the pained family members would have helped them separate and see themselves as worthwhile human beings independent of the disappointment experienced by the other. Without psychotherapy, this family seemed stuck in a pattern in which negativity kept spreading wider and wider. It was a depressing movie, representing a depressing family. As expected, the third generation was also afflicted with this disease of disappointment. Like a malignancy, without intervention, it kept spreading. In an odd way, the movie endorsed my profession. For that, I recommend it.

College Drinking

http://www.cspinet.org/booze/collfact1.htm

 

Frankie, nineteen, sophomore in college, says that partying begins Thursday nights and goes through Sunday night. By partying she means binge drinking and marijuana use. This, she says, is the “college experience”. I know this. I am concerned about this, but the issue in my mind is that if it happens across the country, at just about every college, then when is the behavior concerning? Most of these kids, and likely Frankie too, will graduate college and go on to satisfying careers. Alcohol will not likely be a dominant part of her future life experience. Yet, for some “kids” this binge drinking and marijuana use will not stop, such that they will develop long-term substance abuse issues. It is not clear to me which “kids” are at particular risk, although family history is certainly one important factor. I also imagine that the intensity of partying is another factor. There is a range of drug use among college students, such that I suspect that those who push that range repeatedly are more likely to have life long problems.

“I am glad I started drinking in high school,” Frankie tells me, “because I know how to control myself.” “You mean those who did not drink in high school are learning their limits in college, and they are learning the hard way since there are no parents around to help with self-regulation.” I say, agreeing with Frankie that high school is such an important time to begin to learn good decision-making because parents still have a substantial influence over the superego, the part of the personality that decides right from wrong. In essence, parents, during those tender teenage years, can still exert external control as a way of encouraging internal control. To put it another way, curfews, close monitoring, and rules at home, assist a teenager in learning the importance of self-care and self-regulation. Being too impulsive can lead to self-harm, parents tell their teenagers by making sure that the rules of coming home and school attendance are followed. Sure, some adolescence are naturally good at self-regulation, but for those that want to cater to their impulses, they need rule-enforcing parents to help them help themselves. Frankie nailed it. I think.

“I Am Deeper Than My Parents”

“I am deeper than my parents,” Thais tells me with tears and deep expression of gratitude. “My parents do not understand how they caused me so much grief, but I do,” she continues. “They were each involved in their own lives, doing their own thing, with little regard for my development. They will never see it that way, but that makes sense to me.” Thais’ narrative is interesting to me, not because of the content, but because she is willing to understand her childhood from a different point of view than  her parents have. This kind of mental separation is critical to adult development. Thais is beginning to see her life through her own internal eye, rather than swallowing the story that was told to her about her early developmental years. She is learning that the perspective of the storyteller informs the story. She is also beginning to understand that her parents do not have to agree to her narrative, but it would be nice if they could respect it. As an emerging adult she is beginning to understand the stresses and strains that were on her parents as she was growing up. This understanding has helped her to see why she felt so lonely and deprived during certain critical times in her childhood. This understanding also helps her to see that it was not that she was a “bad kid,” but rather that her parents had to focus on their own survival and so they became less attentive to her needs. This perspective helps Thais build her self-esteem in that she no longer blames herself for the negative feelings she had as a child. She also does not blame her parents in that her narrative allows for the idea that under stress, she can understand how her parents fell short. In essence, she has come to understand that flawed people, which we all are, become flawed parents, and so understanding and forgiveness are at play, along with compassion for herself for not getting the appropriate feedback about her developmental accomplishments. As such, her gratitude to me was a huge gift, in that it was the kind of gratitude which demonstrated how her personal growth has landed her in a much better mental space. Thais and I still have a lot of work to do, but it was a special moment of pause to reflect on how far she has come. Personal growth is a wonderful experience to witness and participate in. The words to describe this experience often feel lacking. Thais is remarkable in her ability to express this sensation.

“I Want Someone In My Life I Can Call When I Go To Trader Joe’s”

Thais, http://shirahvollmermd.wordpress.com/2012/02/22/i-should-have-had-a-manicure/ bemoans the fact that “no one cares about me.” I raise my hand in opposition. “Well, yea, but I mean, I want someone in my life I can call when I go to Trader Joe’s. I want someone to be in my orbit.” I paused to understand her loneliness. I began to see the need to chat about little things, like finding the frozen food or the irritating person ahead of her in line, and that without someone who cares about those things, life can feel so empty, so deserted. As another patient said to me, “no one really cares if I had trouble finding a parking space and that makes me sad.” The sweetness in wanting to exchange life’s little annoyances is so touching, and the lack of a village in which to do that, is so exquisitely painful. Sometimes I wonder if social media, the constant postings on Facebook or Twitter, serves this need-creates this village. Most people need to be heard, not just about the life-changing events of death, divorce or a new job, but more often, for the small, everyday experiences of living life. Thais did not say anything that I had not pondered before, but I was impressed that she was in touch with what was missing in her life. She understood where the hole is, and as such, she knows what she is looking for in a relationship. In the past, Thais would say she wanted “better friends,” but the vagueness of this comment did not articulate what exactly she felt was missing in her life. As she matures, she sees how relationships, both male and female, help her cope with life’s challenges. She no longer “needs friends” in order to be in the “right group,” as she had felt in the past. Now, she needs friends to share her experiences. This is a sea change, and yet subtle at the same time. It is a sea change because she is looking for more depth in relationships. It is subtle because she wants what we all want: she wants to be heard.

‘I Should Have Had A Manicure’

Thais, twenty-one, says “I should have had a manicure,” referring to her drunken stupor last evening. “The guy I liked was flirting with another girl, and I felt terrible, so I wish I had done something nice to myself instead of drinking too much,” Thais continues. “I like the fact that you can reflect on your behavior and see how you might handle that difficult situation in the future. That shows tremendous growth and development. I can see how your feelings were hurt and that you needed to numb them with alcohol, but I also hear that you can also deal with hurt feelings by being especially nice to yourself.” I say, reinforcing how much Thais has progressed in her thinking and reflection over her self-destructive behaviors. Sometimes, psychotherapy is so hopeful.

Adolescent Enthusiasm: It Can’t Be Beat

  Frankie, twenty-one, female, senior in college is elated today. She is doing well at school. She enjoys her friends. She is eating and sleeping well and by her report she has “watched it with the alcohol.” By contrast, a week ago, Frankie felt her life was in the “dumper”. She hated school. She hated her friends. She did not leave her dormitory. What difference did one week do? I am not sure. She did not like how she was feeling so she reversed her mental state very quickly, such that now she is not quite manic, but close. The beauty of seeing adolescents is to witness this rapidly shifting mood state, which means that sometimes just waiting and being patient, the adolescent pulls herself out of one mood and into another mood with the agility that only young people seem to have. Sure, I could try to take credit for Frankie’s improved mood. She saw me last week and we talked about things she could do to improve her self-regulation. I think this helped, but it also helps to have the biology along with today’s culture which allows for a roller coaster of emotion, as somehow a normal and socially acceptable experience in these adolescent years. This rapid shift in mood in an older person would be seen as strange or suspicious, but within our society, we allow it by attributing these mood swings to “normal adolescent turmoil.” Whether we as a society should or should not accept these mood swings is another question. For now, I feel like the beneficiary, as youthful enthusiasm feels like a nice experience to absorb.

Adolescence: The Dawn of Reproduction

 Moses Laufer says that the key to understanding adolescence is to have a deep appreciation for the ability to make a human being, the ability to reproduce. This dawning creates anxiety and hope which shapes the adolescent mind, he claims. Willow, age twenty-four, has never had a serious relationship and she cannot figure out why. Mr. Laufer would say that she is afraid of the sexual demands in such a relationship and the threat of reproduction. He has an interesting point. As an alcoholic cannot have the first drink, otherwise he/she will get drunk, it is possible that Willow avoids the threat of having a baby by avoiding relationships all together. It does make sense that the appreciation of one’s reproductive potential creates, for some, unbearable anxiety. As one moves through the train of adolescence, and one feels egocentric, the threat of being responsible for another human being can be seen as a challenge to one’s developmentally appropriate selfishness. How one deals with this potential says a lot about personality and personality development. I am sure there are many reasons for Willow’s loneliness. Now, Mr. Laufer has added one that I did not consider before. Thanks.

Late Adolescence: A Lesson Of Compromise

Stability of self-esteem is the hallmark of the closure of adolescence. As self-esteem improves, compromise is possible. The adolescent can compromise on their ideals and begin to see all humans as flawed beings who are trying their best to succeed. The arrogance often recedes such that the emerging adult develops a more sanguine approach to the compromises demanded by life’s circumstances.

Zara, twenty-four, exemplifies this transition period from late adolescence to young adult. Whereas in the past, all the adults in her life had “sold out” to corporate interests, now she sees the value of a steady paycheck and the compromises inherent in starting a family. Her stormy period of self-harm, substance abuse, school refusal and school failure are behind her. Now, she is a reliable and responsible person, anxious to become more financially and emotionally independent from her parents. Although she still has issues with how her parents’ conduct their lives, she also sees that choices in life can be agonizing, and so there needs to be some forgiveness for compromising one’s value system. Her judgmental attitude has diminished considerably.

It would be easy for me to take credit for Zara’s emotional growth, and although I do think I should take some, it is also true that the pressure of development, the neurologically pre-programmed wiring to become independent beings, is also at play. As Zara’s brain matures, she feels more of a need to start her own life, and hence be less focused on the flaws of her parental figures. Psychotherapy and development work together to shape Zara’s emerging self. This is a common theme in my blog. Forgive the repetition, but my amazement about the power of development never ceases.