Amae

 

 

http://www.kirainet.com/english/amae-%E7%94%98%E3%81%88/

 

The Japanese language gives us a word to describe how a person, often a child, demands that he be loved and admired, not just to feel good, but in order to grow up and flourish. When I child says “mom, look what I have done,” they are seeking Amae, affirmation and recognition for their accomplishments. This need never changes, but hopefully, with maturity it evolves into a conscious need, such that the person can find constructive outlet for this need, such as running marathons, or producing art.

Psychotherapy, through transference and countertransference, helps to make this need for Amae, conscious, as the patient often pleads with the therapist for attention, which often highlights significant areas of emotional neglect in his past. continuing with the Edna and James dynamic, Edna needs to understand she needs to feel affirmed, not just sexually, but emotionally and intellectually as well. Likewise, James needs to feel like the rescuer, bringing him into a helping profession, but without full consciousness of his need to rescue, to feel affirmed. Amae is not shameful, especially once it is recognized and made conscious. The universality of psychoanalytic principles lives on. Language gives us a way to explore these concepts, and sometimes we need to shift to other cultures and other languages, to convey the many ways in which relationships promote growth.

Do Girls Have A Harder Time?

“Womens’ lives involve deep and primary relationships, with their children, and importantly, with other women.” Nancy Chodorow PhD

“Sex-role development of girls in modern society is complex. On the one hand, they go to school to prepare for life in technologically and socially complex society. On the other, there is a sense in which this schooling is a pseudo-training. It is not meant to interfere with the much more important training to be feminine and a wife and mother which is embedded in the girl’s unconscious development and which her mother teaches her in a family context where she is clearly the salient parent.” Nancy Chodorow PhD

We might expect that a woman’s identification with a girl child might be stronger; that a mother, who is, after all, a person who is a woman and not simply the performer of a formally defined role, would tend to treat infants of different sexes in different ways.” Nancy Chodorow PhD

Brothers and sisters, close in age, give us an opportunity to postulate how families can mean different things to different genders, giving meaning to my frequent comment  that “although you are siblings, you did not have the same parents.” Parental expectations of boys and girls are different, even in our more progressive society, and even after the two waves of feminism. Specifically, boys are expected to have financial independence, get married, have a family, but with, generally speaking, a looser psychological tie to his mother, as time progresses. Girls, by contrast, are also expected to have financial independence, get married, have a family, but also maintain a tightness with her mother. This critical difference in both conscious and unconscious expectation often makes it more difficult for the emerging female adult to find their own path, while at the same time, taking emotional care of her mother, by maintaining a close bond.

Diedre and Ezra, boy and girl twins illustrate the point. Ezra grows up, goes to college, graduate school, gets married, buys a house and is hoping to have children in his early thirties. He married a girl, quite similar to his mom, a remark that almost everyone said at their wedding, according to Diedre. Ezra calls his mom every Sunday and they chat for about twenty minutes. There is little tension, and, again, according to Diedre, Ezra has “checked every box.” Diedre, my fictional patient, has had a more “windy” path, by her description. She went to college, then traveled, then cobbled together some “jobettes” then figured out she wanted to be a speech pathologist, so landed back in graduate school. Meanwhile, her relationships with men have been satisfying to her, but distressing to her mother. She has found men along her journey who had “alternative” lifestyles. Mark, for example, lived out of his car, not because he could not afford an apartment, but because he thought it was a great way to save money. Diedre comes to me worried about her relationship with her mother. She feels torn between “checking the boxes” and doing her “own thing.” Diedre looks at Ezra with contempt and boredom. “He is living a life that looks like a script. I am not sure he even knows what makes him happy,” Diedre says, with a tinge of jealousy. “On the other hand, I can see that he has stability,” she explains her envy. “Still, my biggest problem is that I know my mom worries about me because although now I am on a career path, I am not married, and she never likes the men I am with.” I wonder aloud, “maybe you pick men that you know your mom won’t like, in order to demonstrate to yourself that you are your own person and that you are not your mom.” I say, thinking about how hard, for certain young women, it is to separate emotionally from their moms, and so with this difficulty they go to extremes. “I am certainly afraid of turning into my mom. You are right about that part.” Diedre says, not sure if that explains how she is choosing her boyfriends.

Dr. Chodorow reminds us that girls both want and do not want to be close with their mothers, and this duality creates an unsteady feeling that boys, generally speaking, do not have to wrestle with. Boys are not their moms because they are a different gender, and because their mom does not expect the same intimacy from them. Girls, by contrast, are imbued with a deeper narcissistic investment from their mom and this burdens them into pushing back in ways that create anxiety and uncertainty. Going forward, girls then have babies, which sandwiches them between maintaining the tie to their mom, while at the same time as nurturing their infant. They are thrown into the challenge of parenting, forcing them to “remember” sometimes, by re-experiencing, their own early childhood. Boys, typically, are not on the front lines of infant care, and as such, do not re-live their early childhood so intensely. The complexity of this emotional interior, Dr. Chodorow argues, makes women have harder psychic lives. I agree.

 

See also…https://shirahvollmermd.wordpress.com/2013/10/07/struggle-of-the-sexes/

“Strong evidence” for a treatment evaporates with a closer look: Many psychotherapies are similarly vulnerable.

 

 

 

 

“Strong evidence” for a treatment evaporates with a closer look: Many psychotherapies are similarly vulnerable..

Struggle of The Sexes

“Chodorow sees gender differences as compromise formations of the Oedipal complex. She begins with Freud’s assertion that the individual is born bisexual and that the child’s mother is its first sexual object. Chodorow, drawing on the work of Karen Horney and Melanie Klein, notes that the child forms its ego in reaction to the dominating figure of the mother. The male child forms this sense of independent agency easily, identifying with the agency and freedom of the father and emulating his possessive interest in the mother/wife. This task is not as simple for the female child. The mother identifies with her more strongly, and the daughter attempts to make the father her new love object, but is stymied in her ego formation by the intense bond with the mother. Where male children typically experience love as a dyadic relationship, daughters are caught in a libidinal triangle where the ego is pulled between love for the father, the love of the mother, and concern and worry over the relationship of the father to the mother. For Chodorow, the contrast between the dyadic and triadic first love experiences explains the social construction of gender roles, the universal degradation of women in culture, cross-cultural patterns in male behavior, and marital strain in the West after Second Wave feminism. In marriage, the woman takes less of an interest in sex and more in the children. Her ambivalence towards sex eventually drives the male away. She devotes her energies to the children once she does reach sexual maturity.”http://en.wikipedia.org/wiki/Nancy_Chodorow

This will be our discussion in class  on Friday. Do women have harder lives? According to Dr. Chodorow, yes, indeed, beginning with the Oedipal challenge of falling in love with her father, still intensely in love with her mother, and feeling perpetually torn, leading to the future torn feeling between her husband and her own children. The girl, unlike the boy, can never experience the bliss of a dyadic relationship, as it is challenged by a third-party. The boy, by contrast, can love his mother, admire his father, find a wife, and seamlessly go from one dyadic relationship to another. This Oedipal challenge leaves a girl to experience intense guilt for having a firmer alliance in one direction and not another. So many marriages teeter with the challenge of raising children because the husband, often gets demoted. Second marriages are often about husbands yearning and seeking for the time in his first marriage where he felt like he really mattered, instead of feeling like he was a wallet. How does a woman, expend energy on raising children, while still ensuring that her husband is narcissistically gratified. One could say that husbands should not need this narcissistic gratification from his wife and that he should embrace his new role as a father, but if the dynamics of a marriage are such that the wife makes her husband feel that he is the center of her universe, it would be quite ambitious to think that the husband can gently leave that perch?

Clarene, twenty-seven, is quite tight with her mother, loves her father, and lives with her boyfriend, Stan, much to the dismay of her father, but not her mother. Clarene’s mom likes Stan because he is caring and kind to Clarene. By contrast, Clarene’s dad feels that Stan is not “good enough” but then again, when pressed, Clarene says no one would be “good enough.” “He does not want me to separate from him,” Clarene says, wanting me to know that Clarene’s point of view is that she is “daddy’s little girl” and Stan interferes with that dynamic. Knowing this, however, Clarene is still torn between pleasing Stan and pleasing her father, in a way that might remind her of her childhood when she could not please both parents at the same time. When she did well in school, her mother was proud, but her father said she could do better. Clarene painfully recalls the multitude of times when she wanted to make her dad happy, but she never felt she did. Clarene’s brother, Eliot, never seemed to care if he made his dad happy. Eliot only cared what his mother thought of him, and yet he admired his dad a great deal, according to Clarene. This difference between Clarene needing to please all, whereas Eliot was more narrow in his “love-objects” gives Clarene, and hence all women, in general, according to Dr. Chodorow, the burden of needing consensus among her loved ones. Dr. Chodorow would say that as long as women take care of their children, girls’ lives will always be more complicated by this ever-pressing guilt involved in pleasing one, but not the other. This explains how girls, from a young age, form groups, where the dynamics are critical, whereas boys, focus on activities where slights tend to be less felt or noticed. This long history of emotional complexity may explain why girls migrate towards helping professions, understanding the push and pull of relationships.

 

See also…http://www.latimes.com/nation/nationnow/la-na-nn-pew-moms-exhausted-dads-20131007,0,2841039.story

Mother’s Instinct

Marley, fifty-three year old, mother of three adult children, is in constant battle with her husband, Kirk, over how to help her children launch into adulthood. In particular, Marley is struggling with how to help her oldest, Nan, thirty-two, become more independent. Marley’s instincts tell her that Nan needs the School of Hard Knocks,http://en.wikipedia.org/wiki/School_of_Hard_Knocks‎, whereas Kirk believes that he and Marley should pay for her health insurance, help her out with her rent, and pay for her car insurance. Marley and Kirk cannot seem to come together on this issue, so by Marley’s report their marriage is in deep trouble. “I just don’t know what to do,” Marley says. “I really trust my instincts about what will help Nan. I know the kind of kid she is, and I know that if we help her out, we will take away her incentive to become independent. Kirk thinks I am being too hard on her, but I think she needs the tough approach, since when we supported her, it seemed like her development was stunted. I am not being mean, although Kirk says I am and that is hard on me.” Marley explains how she does not want to compromise and further, she is hurt that what she sees as good intention,s is perceived by her husband of thirty-five years, as “mean”. “Does Kirk think you are a mean person, in general, or only now, with respect to Nan?” I ask, wondering if Kirk is using this conflict as a way to express deeper feelings towards Marley. “No, that’s not it,” Marley says emphatically. “It is just that he does not like conflict, so he wants everyone to get along, and I think that conflict is necessary to grow, especially now that we really need  to help Nan grow. Sure, we could give Nan money, and sure, there would be less tension, but I can’t stand the fact that Kirk cannot see the bigger picture. This tension is hard, but it is necessary. I feel that in my bones.” Marley explains how she is so clear, in her mind, about how to proceed. Now, Marley sees two problems. One, is how to help Nan grow up, and two, how to cope with Kirk, who from her point of view, is conflict-avoidant. “It must be hard when you are so sure of yourself, and yet, you are living with someone who approaches life so differently,” I say, stating how this conflict is bringing up the larger conflict in their long-standing marriage. “You and Kirk are very different kinds of people.” I repeat. “Yes, and when we are not fighting about our kids, that difference is OK, but when it comes to hard decisions, that difference rises to the surface and creates a lot of tension. Maybe Nan will grow up and our marriage will survive, but maybe not.” Marley says, hinting that divorce is on her mind. “Will marital therapy help?” I ask, wondering if they need professional assistance. “Yep, I think so.” Marley says with a bit of hope in her voice.

The Arrogance of Parenting

Judy Garland

 

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.

The Joys Of Parenting-Continued!

Depressed, Pregnant, What To Do?

 

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.

Re-Posting for Mother’s Day” Mothers and Mothering

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.”