Archive for the ‘Mother/Child Relationships’ Category
Posted by Dr. Vollmer on May 6, 2013
Posted by Dr. Vollmer on April 22, 2013
Thinking about Judy Garland, having just seen “End of the Rainbow” http://articles.latimes.com/2013/mar/16/entertainment/la-et-cm-tracie-bennett-end-rainbow-20130317, with fellow psychiatrists, we engaged in a heated debate about the nature of her suffering. ?Bipolar, ?ADHD, was the launching pad for the discussion, and yet my thoughts turned to her horribly sad childhood in which, she made money for the studios, and in the process, she was fed prescription drugs to keep the “machine” going. “Trauma,” I said firmly, in trying to understand this icon. She seemed robbed of a time in her life to “play” even though some might say that acting is a form of playing, Judy Garland had to play like she was told and so, by definition, this was not the kind of play in which she could make up her own rules, and have a time in her life in which her activities were inconsequential. This left an inner emptiness, a “zombie state,” as a colleague of mine says, in which she could never experience the sensation of being alive, but rather she enlisted her superego to do what she “was supposed to,” thereby leaving her feeling without satisfaction or fulfillment. She never had a chance to experience her ego, as her superego was running her life, from such an early age. Her many husbands, it seems to me, provided this superego, until one of them tired of the emptiness. She never seemed to know herself, to know her ego, and as such, she could never find a path towards happiness. As Ray Bolger, her co-star in the Wizard of Oz, succinctly stated, “”she just plain wore out.” Like a machine, the gears could no longer turn. Sad, sad, and sad. There is no diagnosis, as far as I can see, but only an incredibly talented woman who never developed a sense of herself. What do we call that? I call that child abuse.
Posted by Dr. Vollmer on March 28, 2013
Posted by Dr. Vollmer on March 13, 2013
Carrey, thirty-two is not so happily pregnant. She is married. She planned this baby, but her mood is low and she is wondering about antidepressants. “Are they safe in pregnancy?” She asks me, hoping that this is a yes or no question. “It is really a nuanced question.” I say, beginning an educational moment that medications cross the placenta and can impact the development and the delivery of the fetus, so we look to the literature to help us out. The literature tells us about studies which describes what happens most of the time, but there can be exceptions and new information that develops over time. “One question is whether there are other options for intervention, while you are pregnant, which pose a lower risk to the fetus,” I say, highlighting that part of the decision about psychotropics during pregnancy is whether or not other modalities of treatment can be tried and could be useful. Experts in the field come to the conclusion that the decision to treat a pregnant woman with medications comes down to a risk/benefit ratio, which means that each individual patient needs to be evaluated to determine if the risk of treatment exceeds the risk of not treating, with psychopharmacology. First and second trimester exposure appears to cause no organ malformation, but third trimester exposure can cause the baby to be born irritable, perhaps to the point of requiring the baby to stay one extra day in the hospital, and thereby increasing the risk for hospital-acquired infections. Some psychiatrists interpret this data to give them a low threshold to treat pregnant women with psychotropics, whereas other psychiatrists take this data to suggest that non-pharmacological interventions should be tried intensively before jumping to medication. There is no agreement, and there are no specific guidelines. This uncertainty in the field causes patients to be confused and, sometimes angry, at physicians who do not share their point of view. With this grey area of treatment, comes a lot of subjectivity about how to proceed which leads to professionals being judgmental with each other, and patients looking to professionals who lean in the direction they are looking for. Carrey is confused, seeking other opinions. I respect that.
Posted by Dr. Vollmer on May 13, 2012
Cheryl, forty-nine, mother of two adult children, called her mother Maureen, eighty, to tell her that her dog Candy passed away suddenly. Maureen said, according to Cheryl, “well, honey, you can’t get so upset about every little thing.” Cheryl reported to me that she was “flattened”. I responded “you have a mother, but you don’t have mothering,” trying to express to Cheryl that not all mothers are nurturing, even though one often hopes for that. It seems true that a nurturing mother helps a child to grow up with good self-esteem. “Yes, but I always thought that I was doing something wrong such that my mother could not nurture me. She seemed to nurture my four siblings, but not me,” Cheryl says with great sadness. “What do you think you did wrong?” I ask, hoping that Cheryl will come to see that as with most children, she is blaming herself for her mother’s foibles. “I think I am too intense. I think I am a hard person to soothe. I am never satisfied.” Cheryl says, as if ready for my question. “Even if that were true, it still seems that your mother did not try to empathize with your pain, either now, or in your past.” I say, trying to stress that mothering implies working with the temperament of your child in order to find ways to nurture and support them. “I am just going to stop speaking to her,” Cheryl says, trying so hard to stop the pain. “Well, you could do that, but you could also change your expectations,” I say, stating the clear point that Cheryl can learn not to be ”flattened” by the insensitivities of her mom. “Needing mothering is different than needing your mom to give you that mothering,” I say, trying to parse out the need for nurturing from the person one expects to provide it. “I am sorry Candy passed away,” I say, knowing that I may sound as if I can be a substitute for Cheryl’s mom. Cheryl looks at me knowingly. “Thanks,” she says, “but it is not the same.”
Posted by Dr. Vollmer on February 16, 2012
Leanne, fifty-one, is always confusing appointments, losing pieces of paper, and is in general a very disorganized person and a disorganized mom. Lesley, her twelve-year old daughter, feels she can’t count on her mom to follow-through in a timely fashion on scheduling doctor visits, or picking up things she needs so that she can be in the school play. Lesley compensates for Leanne’s unreliability by making a multitude of lists in which she tracks what needs to get done. At the same time, Lesley is constantly in a state of anxiety in which she is worried that she will not complete her task list. Lesley’s dad has suggested that she take medication for her anxiety. I question Lesley, “do you think you would be so anxious if your mom was more organized?” I wondered if Leanne’s unreliability made Lesley feel fearful that so much of the responsibility of moving forward in her life now fell on Lesley since her mom was not providing a safety net for her. In other words, the maternal role for an adolescent child is in large measure the job of making sure that the teenager can go to their various activities and that they have the right supplies. Without this infrastructure, teenagers are going to be impaired in their ability to engage in multiple life experiences.
Lack of reliability can create anxiety in someone who is dependent on them. That is straightforward. Am I “blaming” Leanne for Lesley’s mental state, or am I understanding what Lesley is up against? Am I stepping on the therapist’s toes, by suggesting that the more Lesley understands that she is anxious because her mom is disorganized, the better Lesley will be able to cope with the demands of her life. The nature/nurture debate continues. Lesley is probably wired to tilt towards anxiety-an internalizer as we say. Her environment exacerbates her condition. She can learn coping skills and she can probably also benefit from medication. This is not a binary system. Yet, our brains wish for binary. We want answer, and sometimes that answer is medication. Multiple answers are usually harder to grasp, especially in crisis. Staying broad-minded is the goal. Lesley is going to do well. She needs help understanding her mom and her mom’s frailties, and she also needs help understanding the vulnerability in her brain to be anxious. She is up for both of those tasks. So, chicken/egg, does not matter.
Posted by Dr. Vollmer on February 8, 2012
Daniel http://shirahvollmermd.wordpress.com/2012/02/07/the-aggressive-child/ is out of control in that he throws chairs when he gets frustrated with his video games. He punches his mother when she asks him to do homework. Is the problem a parenting issue or a mental health problem or both? Although seemingly complex, the issues become straightforward. All children, especially aggressive children, need to have very clear limits: a “holding environment” as Winnicott has taught us. By clear limits, I mean that Daniel has to be told that hitting is not acceptable. He needs help to use his words when he gets frustrated. He needs to be exposed to video games which are age-appropriate. He needs to have guidance with self-regulation when it comes to eating and sleeping. The parents need to make sure that he eats well and has a regular bedtime. They also need to make sure that the school is attending to his academic and emotional needs. Finally, they need to make sure that Daniel is exposed to playdates so that he has the opportunity to learn social behaviors from his peers. When all of this is in place, and Daniel still has problems with frustration and aggression, then the discussion about diagnosis and medication management needs to begin. It is not that Daniel’s parents are responsible for Daniel’s aggression, it is that Daniel’s parents can provide the basic nurturing environment such that we can see that even with a clear “holding environment” whether Daniel can control his impulses. It is hard to know if Daniel can control his impulses when the environment is chaotic and unpredictable. In this latter circumstance, many kids, with or without a mental illness, become anxious and physical. I think I am stating the obvious, and yet controversy ensues. What am I missing?
Posted by Dr. Vollmer on July 15, 2010
Zachary, http://shirahvollmermd.wordpress.com/2010/07/10/no-gravity-anxiety/ and http://shirahvollmermd.wordpress.com/2010/04/14/prescription-drug-abuse/ says “I don’t like my mom; what is wrong with me?” I ask the obvious question, “what makes you think there is something wrong with you because you don’t like your mom?” “My friend was saying that families that don’t talk to each other are messed up, but then he remembered that I was not speaking to my mom and then he felt bad,” Zach says. “And so did you,” I quickly reply.
Zachary depended on his mom when he was growing up. He needed her for physical and emotional nurturing. His dad went to work every day and he got home late. He is the oldest, so he could not count on his siblings to help him mature. He grew up isolated from his extended family. Sadly, his mom suffered from severe anxiety and depression, with many periods in Zach’s childhood where she stayed in her room for hours on end, as Zach was playing at home after school. Zach took his mother’s withdrawal as an abandonment; as a child, Zach felt that he caused his mother to retreat. Despite these negative feelings, Zach moved forward in his life. Zach’s relationship with his mom changed. As Zach matured into adulthood, his mother would often yell at him for not paying enough attention to her. Zach went to college, found a career, married and moved to another city. According to Zach, his mom took all of these developmental steps to mean that Zach did not care about her any more. Zach eventually grew tired of feeling guilty that he was not attentive enough to his mom. In his thirties he decided that talking to his mother created so much stress for him that he could no longer have a conversation with her. His mother, according to Zach, does not understand why Zach does not talk to her. At the same time, she does not pursue a relationship with him.
When parents suffer, for whatever reason, children inevitably blame themselves. As the child grows into adulthood, this self-blame persists, despite the fact that the adult child can see the guilt as irrational. Zach understands that talking to his mother is harmful. Every conversation turns into a discussion about his mother is disappointed that Zach is not more involved in her life. Consequently, Zach decided to stop talking to his mom; the emotional cost of this decision is huge. Zach carries a tremendous amount of guilt and self-loathing when he thinks about his mom, but at the same time, he feels it is the right decision not to call her.
At forty-one, Zach needs to separate from his mom emotionally. He needs to see her as a human being who became a mother, which for Zach, meant that he experienced an empty and abandoned childhood. As Zach can distance himself from the emotional frailty of his mom, he can begin to see that her emotional fragility lead Zach to feel bad about himself. Later on, Zach’s mother demands for Zach’s attention continued to make Zach feel inadequate. A healthy emotional distance from his mom will let Zach free from his self-imposed sentence of guilt and self-loathing. http://shirahvollmermd.wordpress.com/2010/07/13/self-loathing/. Zach’s freedom to say that he does not like his mom, is the first step for him to talk about how he feels his mom hurt him emotionally. Zach’s courage in his honesty is admirable. The work ahead of him demands more courage. Luckily, he has what it takes.