Child Safety

http://www.latimes.com/business/la-fi-lazarus-20120831,0,2539605.column

Accidents at home, leading to children dying keep happening, despite media attention and legal action. Cords are dangerous for children. Even cords within the blinds hurt and kill children. As a Child Psychiatrist, as a human being, I want to use this media to encourage folks to be mindful of household dangers. Prevention goes a long way.

The Disinterested Dad

Samantha, fifty-seven, calls her dad once a week, every Sunday. The conversation is the same, she tells me. “We talk about his medical problems, he does not ask about me or my children. Sometimes I volunteer information. Then, he has to return to his poker game.” Samantha tells me with a resignation that implies she knows how her dad feels about her. By her account, her dad appreciates Samantha’s interest in him, but he does not, has not, reciprocated that interest. “I always feel sad when I hear about how other people have fathers that take an active interest in their lives. That is so foreign to me,” Samantha says, letting me know that most of the time she does not think about this painful relationship, but occasionally there are triggers which bring her back to the pain. “Not all dads are curious about their children,” I say, demystifying the belief that all who become parents have a deep emotional connection with their children. “Yea, I know that. Sometimes my friends feel that because I came from an upper middle class family, my dad cared about me, but it certainly did not feel that way to me,” Samantha says, voicing her frustration about the assumptions her friends have made about her life. “It sounds like you need affirmation about how you feel.” I say, wondering why she needs her friends to understand this. “It is not so much that I need affirmation,” Samantha responds, “it is more that I need my friends to give me the space to have my experience of my dad, and not the experience they think I had.” “Oh, I see what you mean,” I respond. “You need your friends to accept your perceptions and not try to talk you out of them.” I say, understanding that the issue is not how she feels about her dad, but how she feels about her friends. “That’s right,” she says, affirming me in that moment.

Parenting Your Spouse

Lizelle, fifty-four, three grown children, is staring what some folks term the “third chapter,” the time in life where her kids are financially independent, living outside the nest, and she now has the opportunity to explore more self-centered activities. Here parents are elderly, but independent. She has no grandchildren. Her vision of this phase of her life was one in which she would “find herself,” meaning she would discover a passion. She imagined a life where she re-lived her adolescence, exploring things she never ventured into before. To her surprise, her husband , Tom, of thirty years, steadily employed, began to appear sluggish, although he denied any mood symptoms. Lizelle felt like she had to parent Tom. “I can’t believe it. I feel like I have to get him off the couch and introduce him to ‘after-work activities,’ in the same way that I pushed my daughter into not just coming home from school and vegetating in front of the computer. I feel like I have to insist that he find something he enjoys outside the house. This makes me feel like I have a child and not a husband,” Lizelle laments.  “Maybe part of marriage is parenting one’s spouse from time to time,” I say, contradicting the notion that Tom is childlike, and introducing the notion that marriages have many different modes, and one mode that can pop up is a parent/child type of interaction. “This can go both ways. The need for nurturing does not mean that your marriage is bad.” I say, trying to help Lizelle look at her situation from a different perspective. “I think you are frustrated because in your fantasy life you became an adolescent, so you did not factor that you are still responsible for your husband so you are not as independent as you thought you would be.” “Yes,” Lizelle responds enthusiastically. “I managed to create a fantasy in which I was single.” Lizelle says, laughing at herself, while she realizes that it is obvious that in relationships, people need each other from time to time. “I think I am just a selfish human being,” Lizelle says with a tone of sarcasm, but also expressing a wish that she could be more selfish. “That is not a bad thing,” I say, noting that there is a time for selfishness, in addition to a time for nurturing. “The balance is the challenge.” I say. “Yea, yea, yea,” Lizelle responds.

Genes and Politics: We Knew That

http://www.latimes.com/news/science/sciencenow/la-sci-sn-politics-genes-republicans-tampa-20120827,0,6578432.story

 

The nature/nurture argument never ends, but as we come upon a presidential election, there is support for the notion that our poltics are genetic. Interesting that the article mentions that children tend to think like their parents until they leave the nest. Of course, as with all nature/nurture arguments, most kids are biological children, so one would assume they share genes which make them think in similar ways. The most interesting part of the article is the following:

“‘Modern questions about immigration are similar to the primal need to recognize and deal with out-groups,’ they wrote. Attitudes about welfare reflect age-old questions about               sharing  resources, while views on foreign policy are the modern-day equivalent of concerns about protecting one’s tribe.”

Once again, aspects of personality, generosity versus frugality, for instance, are largely genetically determined. Does this mean we can’t get mad at our spouse for genetic differences? Hmmm…

Breaking The Frame

The frame in psychotherapy, the play-space, is the parameters which create boundaries. The situation is mostly confidential (with the obvious exceptions of reporting child abuse and suicidal behaviors), the start time is established, as is the stopping time. Fees are discussed and payment is due at a certain time. Contact outside of sessions are negotiated. Sometimes, clinical intuition dictates breaking this frame. Laura, fifty-seven, just lost her dad. Should the frame change? Should appointments be longer. Should she get “extra time”? If so, could this damage the relationship down the line? Would this be confusing for her? The frame gives comfort. There is solace in predictability. There is anxiety in uncertainty. The individuality of this field makes it so that there are no clear answers. There is only the understanding that breaking the frame can be helpful and/or hurtful, and I need to be mindful of this at all times. Laura was grateful for the change in parameters. Giving her more time just seemed humane under the circumstances. Sometimes common sense has to apply.

“To Be Alone In The Presence of Another,” Winnicott (1958)

Therapy offers, as Winnicott eloquently says, a patient “to be alone in the presence of another.”  Deep relationships offer this as well. This is the  luxury of experiencing one’s internal world, while a caring person is present in the room, but not intrusive into one’s internal process. Parents provide this for their children, or at least most do. They allow their children to play, without interruption, but they are in the room, or in the house, representing a caring person who is content knowing that their child is entertaining himself. This model of relationships is especially critical to those who feel that their internal worlds are constantly disrupted by an intrusive other. “I want to kill my wife,” Ward, forty-one, says to me, not looking for a response, but wanting to experience his own feelings in my presence. To say, or even to think, “you don’t really want to kill your wife,” would invade his internal space of feelings and fantasies. This tolerant approach allows Ward to explore his frustrations, anger and disappointment with his relationship. To intrude, or to interrupt, would cause him to question his feelings leading to internal confusion and harsh superego judgment. Indeed, the art of deep relationships is to allow the other to be alone in your presence. A lay person might say this is about  “giving him space,” and Winnicott would add-on by saying, yes, but while you are physically present. Winnicott shines again.

The Autistic Spectrum: Problems With Imagination

Carson, a thirteen year old boy, I have known since he was six, has always “suffered from a lack of imagination,” I said to his mom. When he was in latency, his play consisted of banging toys together, without creating a narrative. His play was limited to being aggressive with his toys, without the ability to create stories around his aggression. Now, at thirteen, he reads voraciously, but only about the guns used during the Civil War. The narrowness of his interests are startling. He prefers to be alone, with very little interest in friends or family. The persistence of his restricted interests suggests that his brain only fires up with a minimal slate of activities. His mom, Kerrie, agrees and understands. She always has. It is not that Carson does not enjoy his life. It is that he is an outlier, a child who does not fall in the bell-shaped curve in terms of his leisure activities. Imagination, like every other skill, falls into a spectrum. As with all spectrums there are people in the extremes. Understanding is the first step. Kerrie models this step for so many parents. She intervenes and helps Carson, while at the same time, accepting his limitations. I admire her.

Calling My 232 German Friends….

 

I am looking for teaching opportunities in Berlin. Any ideas?

The Forgotten Sibling

Theresa, https://shirahvollmermd.wordpress.com/2012/08/17/the-self-righteous-memory/, went to Becky’s house for a gathering of family and friends. Becky is one of Theresa’s older sisters and she lives around the corner from Theresa, yet Becky and Theresa hardly speak. Theresa introduces herself as “Becky’s sister” to a consistent response of “oh, I did not know about you.” One friend went even further. “We had dinner with Becky on many Friday nights, and your parents were always there, but we never heard about you.” Theresa, not shocked, but hurt, understood that in her younger years, her siblings and her parents were mean to her, but now she discovered that in her later years, they mentally erased her from their internal landscape. “In a way, this makes sense,” Theresa tells me. “I avoided them for years because they were so cruel to me, so I can understand that rather than feeling rejected by me, they just pretended I did not exist. Still, I was really hurt to hear this.” Theresa tells me, with a confused sense of pain and disappointment. “I can understand you being hit by not being recognized as a sibling, both by your sister and by your parents.” I say, trying to picture Theresa standing at this party, realizing how her family tried to delete her from their lives, while at the same time, they maintained enough contact to invite her to this recent gathering. “It is hard to process,” I say, seeing confusion and pain on Theresa’s face. “Yes and no.” Theresa says, referring to the many years where we have discussed the painful dynamics of her family. “I knew that whenever I go to Becky’s house, which fortunately is not that often, I am going to be hit by something. I always am. I always brace myself. There has been so much bad blood for so many years, that I know that more will surface with each contact. On the other hand, I did not know it would hit me like this. Imagine how her friends felt, knowing Becky for over thirty years and not knowing that I existed. That must reflect poorly on Becky. I would imagine. During that time, I have had significant trauma in my life, so I can’t imagine how Becky did not talk about this with her friends, but maybe she didn’t. Maybe her lack of concern for me is worse than I thought.” Theresa says, as if she is reaching a new level of pain as she thinks about her relationship with Becky. “My friends know Becky exists, even though they have never met her. I guess I care more about Becky than she cares about me. As the younger sister, I so intensely looked up to all of my siblings. I can imagine that as the older sibling, Becky wished that I was not born because I took away our parents’ attention. I guess that wish never went away.” Theresa says realizing that sibling rivaly is so different, depending on birth order. “She might have wished you were not born, and then pretended that as she got older.” I say, highlighting that people speak in wishes. “Wow, that is deep,” Theresa says as she leaves the consultation room.

Relationship Problems, Otherwise Known As The Porcupine Dilemma

In Parerga und Paralipomena, published in 1851, Arthur Schopenhauer created a parable about the dilemma faced by porcupines in cold weather. He described a “company of porcupines” who “crowded themselves very close together one cold winter’s day so as to profit by one another’s warmth and so save themselves from being frozen to death. But soon they felt one another’s quills, which induced them to separate again.” And so on. The porcupines were “driven backwards and forwards from one trouble to the other,” until they found “a mean distance at which they could most tolerably exist.”