Predicting Success

Hard work, intelligence, creativity, motivation, qualities that many people associate with success. Of course, the first point is to define success. If, for the moment, we assume this means establishing financial independence, contributing to society and having loving and meaningful relationships. Luck is certainly a factor, but chance favors the prepared mind, and so as I work with many young adults, I begin to see the differences in life vision, determination and the pressure, whether internal or external, or both, to be on a “course” towards stability. These factors seem to create a stew, which, makes academic success, just one potential ingredient towards a “good life”. Wyatt, twenty, comes to mind. He was a poor student in high school. He went to community college, and then transferred to a prestigious university. He wanted to be a writer, but he realized that financially that would be challenging, so he has switched gears and now he wants to be a physical therapist. His friends were shocked at the transition, but he says “I know I can run a good business and help people, and I have always loved sports, so I think I will get a lot of satisfaction over helping people get over their injuries.” I was so moved by Wyatt, having known him since he was six and seeing report card after report card which says that he was not working to his potential. Now, after all these years, Wyatt seems to have, almost instantly, matured into a nice young man with a vision for his future which is both practical and, by his account, professionally satisfying. Could I have predicted that Wyatt would come to such a focused place in his life, by the age of 20? I am not sure, but I think so. Wyatt had his own way in which he wanted to be in his world. He played nicely and he had nice friends. He could have done well academically, but he never saw the point. His parents were concerned, but not hysterical. He loved sports, but he was not a stellar athlete. He was always calm, to the point, of not caring enough, but perhaps, in retrospect, his equanimity was due to his inner confidence that when things mattered, he would rise to the occasion. Wyatt has a bright future. With the benefit of hindsight, it was great that his parents did not pressure him to get good grades, because he has both self-esteem, and focus, traits which seemed to have grown from finding his own path. Wyatt has , what self-psychologists, call agency. He is running his own life, as opposed to trying to impress others. If others, such as myself, are impressed, he appreciates that, but that was not his goal. Wyatt reminds me why I am a child psychiatrist. I can hold the big picture in mind, so that Wyatt’s parents, can have perspective, when the teachers are concerned. This is an art, and not a science, and so I am not saying that I can look at a six-year-old and tell parents the future for their child, but at the same time, I  do have some ideas about that. Go Wyatt!

“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..

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.

Social Media: The New Baby Monitor

Understanding the impact of new technology on mental states grabs me. Shelby, fifty-one, explains to me how her life has improved substantially because as she has been included in her adult  children’s social media, she is reassured that they are safe. Prior to facebook and twitter, Shelby had significant anxiety about the physical safety of her children. One might think Shelby suffers from an anxiety disorder, and maybe she does, but she also suffers from a history of trauma where she witnessed the death of her sister as her four-year old sister, when Shelby was six, stepped off a curb,  and Shelby watched as a car hit and killed her sister. This memory, etched in her brain, has trailed off in her brain with an intense anxiety about the safety of her progeny. Then, with Facebook, Shelby’s life instantly improved. Every time she saw a posting from one of her children, she reasonably assumed that her child was breathing. As she says, “facebook  is better than a baby monitor.” Her children are aware of this dynamic, and for them too, according to Shelby, it is a lot simpler than calling to check in. Her children know what happened to Shelby’s sister, but Shelby is not sure that they connect the dots. “They don’t have to,” she says with firmness. “I am just so happy that they post, because I just cannot describe the relief I feel.” Shelby says with a power of someone who has lived through an overwhelming trauma. “I am happy for you that social media has improved your anxiety. I do not think that I would have ever seen social media in that way before, but now I do. ” I say, describing how Shelby no longer needs medication to deal with her anxiety, as social media has served the same function. Upon reflection, I can see how social media might improve the anxiety for so many, beyond those with Shelby’s history. Feeling the “touch” from a posting, can feel warm and cuddly. Global warming  has a new meaning to me.

Wanting More

 

Penny, forty-seven, has a nice husband, three teenage sons, a good job, financial comfort, plenty of friends, and yet, she feels something, she is not sure what, is missing from her life. She comes to me searching for what is missing, searching for why she feels unsatisfied. Her life, she tells me, has come to feel mundane. She wakes up, packs the kids lunches, takes them to school, goes to work, comes home, makes dinner, helps her kids with their homework, only to start the routine all over the next day. She is also an avid cyclist, where one weekend a month she does century rides, meaning she rides 100 miles in one day, reminding me that she does take time for herself, to do what she wants, so she does not just feel like her life is constantly doing things for others. She loves her kids and her husband. Her family of origin is emotionally distant, but she seems to have come to terms with that. She describes her mother as “horribly narcissistic” and her father as “non-existent,” even though her parents have now been married for over fifty years. “What do you think is going on?” I ask, wondering whether the issue is her sense of ownership over her accomplishments. I float the hypothesis in my head that although her life looks great from the outside, on the inside, she has never felt like the steward of her own ship. I am wondering if she feels like a “victim” of good things, in that her life has worked out well, but almost, by accident. She responds, “I think I just feel lost. I don’t know how I got here and I don’t know where I am going. What will my life look like when my kids go off to college? Right now, they are my anchor, but I know soon that won’t be there and then what?” As Penny talks, I begin to feel her sense that life is taking over her and she is not taking over her life. I have this strong feeling of helplessness coming from her. “Do you think you could find another anchor?” I ask, helping her to think that she can feel in control of her life, while at the same time knowing, that many things in this world are out of our control. “Yea, I think I can, but before I had kids I did not have one, so I think it is going to be particularly hard for me.” Penny explains how her kids gave her a sense of gravity and she is very fearful of having that free-floating experience where life feels constantly uncertain. “Your friends and your husband don’t seem to make you feel like you belong somewhere, in the way that your kids do,” I ask. “Yes, that is right,” she says with the enthusiasm of feeling understood. “My husband and friends can find other people in their lives, but my kids have only one mother.” Penny responds quickly, suggesting that she has thought about this before. “Yes, that is true, but maybe you have put up walls with both your husband and your friends which don’t allow you to get too close to them,” I suggest, thinking that her only deep emotional investment was with her children, and so now she is running scared. “I think there is truth to what you are saying,” Penny says, with sadness and despair.

Losing Children: Helping Others…

http://www.latimes.com/features/image/alltherage/la-ar-bald-most-beautiful-bush-shaves-head-to-support-cancer-patient-20130725,0,1931521.story

George H. W. Bush, lost his four-year old daughter, Robin  to leukemia. More recently, many many decades later, he has shaved his head in solidarity with this little child, the son of a secret service, who also has leukemia. The enduring aspect of his parental pain comes through as this story is portrayed to today’s LA Times. Every parent can imagine the anguish of losing a child. Yet, not every parent goes public with their loss for fear of pity, shame, and/or triggering overwhelming grief. Former President Bush gets a lot of credit for keeping the memory of his daughter alive through this current action of shaving his head. The article gives humanity to a man who has long been out of the spotlight, but returns now in this touching way. Regardless of political leanings, the unification of parents helps us get through difficult times. Through such deep sadness comes a world which feels a little warmer. I salute you..Former President. George H. W. Bush.

Stories About Places

What’s Your Story? Write, edit and record your own Berlin Story Original (in English) and upload it to our SoundCloud group by the end of June. The winners will be broadcast on NPR Berlin and Worldwide.

 

Stories about places seemed like a cool idea, as I trolled around the internet and I found the above contest. So, below I wrote a fictional vignette about Sofia, Bulgaria. Places are the springboard towards meaning making. When we go to a new place, the old gets woven with the new and so stories can be told.

 

My Bulgaria story begins at Mariannen 52
the place my twenty-seven year old daughter jumped to from New York. I needed to visualize her surroundings. Of course, we could Skype or do Facetime, but that seemed inadequate. I needed to see where she slept, where she went to the market, what her bathroom looked like. So, to the shock of many friends, I decided that a long weekend from Los Angeles is all I needed to satisfy my hunger. I saw clients Thursday morning, hopped on a flight  to London, changed planes to Sofia, and by Friday afternoon, I would be at Mariannen 52. Monday morning I would return to Los Angeles, allowing me to return to my office for Monday evening clients. I knew that I was not there to linger, only to form visualizations that would help me see that my lovely adult daughter had a life that I could imagine. So, Mariannen 52, was indeed quite a special place, making me so proud that my daughter, as she has done repeatedly, takes such good care to create living situations which are not only adequate but quite comfortable and homey. The building had an elevator, making me prefer it to her first New York apartment, where the five floor walk-up got tiring, even though I usually appreciate a physical challenge. The apartment is a sublet, so all of the photos are from another couple. I thought that made for some interesting living experiences. I wondered what it was like to be surrounded by someone else’s special things. The bathroom was nice. I used it a couple of times. The balcony was a special treat and the kitchen was more than adequate. I could have slept there, but having separation seemed to make sense to me. As much as I wanted to come and see her, to see her in her environment, I was fearful of crowding her in her own space. In about ten minutes, I had satisfied my desire. Those ten minutes made me appreciate, not only my daughter for her remarkable resourcefulness, but also for Sofia, a city which gives my daughter the opportunity for a European experience where she can be an artist and live comfortably. I remember that. It is a vibrant place with lots of young people meandering the streets. She fits in. I am almost instantly relieved. Two planes, twelve hours of travel, a nine-hour time change, for forty-eight hours on the ground, is all worth it. Mariannen 52 is a special place. My daughter lives there.

 

Dorsolateral Prefrontal Cortex (DLPFC): Heart Of Life’s Success

According to Wikipedia…..

“DL-PFC serves as the highest cortical area responsible for motor planning, organization, and regulation. It plays an important role in the integration of sensory and mnemonic information and the regulation of intellectual function and action. It is also involved in working memory. However, DL-PFC is not exclusively responsible for the executive functions. All complex mental activity requires the additional cortical and subcortical circuits with which the DL-PFC is connected.^[2][3]

Damage to the DL-PFC can result in the dysexecutive syndrome,^[4] which leads to problems with affect, social judgement, executive memory, abstract thinking and intentionality.^[5]“

Academic Child Psychiatry, and Laura Tully PhD, in particular,  is trying to understand how social skills work on a neuroanatomical level, and in light of that, all roads point to the importance of a well-functioning dorsolateral prefrontal cortex (DLPFC). When this part of the brain works well, people can plan, anticipate, organize, empathize and thereby make good judgments, socially and otherwise. These findings deepen my appreciation for genetics, and how much of behavior, and positive outcomes, are based on DNA. Unempathic parents can disorganize a good brain, a good child, but empathic parents cannot replace a defective DLPFC. In other words, I think of the nature/nurture argument, as often supported by Steven Pinker PhD at Harvard, that growth is pre-determined, but malnutrition can change the outcome. A good diet cannot make someone taller, but a bad diet can make them shorter. So too with behavior. Good parenting does not always create “good” kids, but “bad” parenting can hurt “good” kids. The basic ingredient, a good DLPFC, is essential for life success. It is almost impossible to compensate for a defect in the DLPFC, as seen by people with head trauma resulting in damage to this area. Understanding the need for good brain functioning, helps parents of children with mental handicaps understand their limitations, as parents. Likewise, parents of children who do have good  brain functioning, need to understand that  their main job is “not to screw it up,” as I like to say. Nature and nurture go together, but understanding how this dynamic plays out, is essential to promoting the best development possible.

Parenting Frustration: New Yorker Caption Contest

 

“I take futility to a new level.”

The Arrogance of Parenting