Sunday, April 4, 2021

Callousing to Divorce

 I'm on a number of professional "list serves" that exchange ideas, resources in which colleagues also seek referrals from one another.  Something just crossed my eye that saddened me regarding how calloused we have become to one another's pain.  

Callousing is not necessarily a bad thing.  Our feet are very calloused.  They endure great amounts of pressure and demands in carrying the weight of our bodies as we depend on them daily without our consideration to the demands made upon them.  Professionals learn how to callous as well.  The emergency physician has to learn to callous to the pain of the patient in order to properly diagnose and treat the problem.  A physician focusing only on the pain of the wound may not do very well in treating it.  That's why physicians are trained to not treat their families.

In the field of mental health we are trained to strike a balance.  We we have to create an emotional connection with clients - after all, that's a large part that motivates their first call.  They need to speak with someone who they can trust, someone who convincingly understands at an emotional and intimate level whatever they're experiencing.  At the same time mental health professionals must not get too drawn into the pain of their clients lest they lose their professional objectivity.  The balancing of these two things, objectivity with empathy is an ongoing and difficult balance to be struck.  

So, while reviewing my in-box, it caught my eye when a request for a therapist for a child was made.  The child, the note said, had "no underlying issues."  So far so good.  Some kidsvjust want to talk having had to external crises or precipitant.  The next sentence, however, stated that the child's parents had recently divorced.  

Yes, divorce rates are high, and that's a valuable topic of discussion for another time.  But for it to be so commonplace that we describe a child who has suffered the dissolution of their family structure to not be an "underlying issue" seems to me a bit too calloused a presumption.  

Have you ever broken a bone?  A finger, wrist, arm or leg?  Or have you  brought a family member or friend to the hospital with a broken bone?  When it's yours, it's not so simple, even though broken bones are common and usually easily repaired.  

I will hold that a child's losing the structure of the family is indeed an underlying issue.  It's huge.  Let's remember what the function of parents provide a child:  A child from it's first moments in this world creates emotional bonds with parents.  Throughout it's infancy and for years to come it learns how to distinguish between it's primary caretakers.  Usually that involves two parents.  Sometimes it's one, or a parent and some other adult, maybe a grandparent.  Whomever the primary caretaker/s are is with whom the child creates a primary attachment that is the model of attachment in the future.  Parents provide the child with a foundation upon which the child depends.  When that foundation gives way the entire structure of the child's life is changed, regardless if the structure of the family is a single parent, same gendered, multi-generational or typical.  

Fascinating research has been done in the wake of children's experiences after severe earthquakes.  The one thing they had always been able to depend upon, the earth's stability, now having been compromised, effects the child's experience of security and safety.  So too the parental unit that becomes unstable, jeopardizing the entire emotional foundation upon which the child has build his or her emotional world.  

Regardless of the frequency with which such traumatizing events occur, I pray that we not become so calloused so as to diminish the weight of the value of typical family structure.  

Thursday, December 17, 2020

What Does That Mean?


I recall the astonishment when, as a student exploring a career in mental health, I entered counseling and was asked about a certain (now forgotten) topic: “What does that mean to you?”  It was so clear to me.  How could it not have been clear to him?  I believe myself reasonably articulate, so I couldn’t imagine what was not clear about what I had said.  I perceived a brashness in the question that caught me off guard to the point of offense.  I believed myself to have been quite precise.  Over time I’m not so sure I was. 

The question of "meaning" has stuck with me.  Finding meaning is, after all, a fundamental function of our higher brain.  It’s high on Maslow’s hierarchy of needs, not a primitive “shelter” function.  It drives us and pushes us.  It’s integral to our marriages and families.  Viktor Frankel’s seminal work Man’s Search for Meaning compels us towards understanding what things mean.  We are obligated to strive to define meaning, but it’s not always as clear as our first draft may appear. 

That search pushes us in a variety of ways, all of which I believe are healthy.  Whatever we might be talking about, whatever is on our mind may be the thing which we are attempting to clarify.  Once we do so, we might want to share with our spouse, our kids and friends the new awareness we have found.  Sharing what has meaning to us increases attachment between us and our loved ones.  And if we fear what we find, that means something too – probably something quite important.

The essence, I believe, of understanding what things mean to us is the demand it creates to articulate our beliefs, thoughts, and feelings.  That use of language, the crafting of our thoughts and emotions into words serves a critical function for us.  Language holds the ability to convey ideas with impact, strength, nuance, clarity and conviction to ourselves as well as to our intimates.  Thus, when you consider what things mean to you, it’s worth taking a moment to find the right words.  You’re not pouring concrete - you’re not married to the words.  Meaning is a lifelong evolution.  Use your friends or spouse to bounce the ideas off of.  Listen to their questions and comments.  Craft your message.  Ponder it.  Think about it.  It will mean a lot. 


The Unexamined Family of Origin


A colleague of mine posted in her office: “Parenting doesn’t come naturally.  What comes naturally you learned from your parents.  It takes work to do it differently.”  Most adults reach a point where they can objectively critique their parents’ style of parenting as well as their marital dynamics.  Socrates criticized “The unexamined life…”  We also have an obligation to examine the dynamics of our families of origin.  It is crucial for us to understand our patterns of communication and how they may reflect the imprint we received from our parents.  Without such examination, we can unknowingly influence the nature of our marriages and how we shape our children. 

How well did our parents communicate with one another?  How did they cope with the stresses, large and small, that life brings?  How did they negotiate parenting responsibilities or children’s challenging behaviors?     How did they cope with emotions?  And most importantly, how did they resolve conflict?  Solid research shows that parental stress effects the welfare and mental health of children – a particularly important point during this period of COVID causing all of us increased stress.   

Parent modeling can influence for the lifetime of the child and may be passed down for generations.  It is the source of the phrase “generational patterns of_______.”   Fill in the blank with words like “abuse,” or “addiction,” “emotional distance.” Contrast that with works like “scholarship,” “leadership,” or “kindness.”  

When parents lack the skill to reach a healthy and lasting resolutions in life, children know.  Children are sponges absorbing how happy parents are by something as benign as how parents ask one another to pass the salt.  And don’t think it’s all about volume.  Quiet resentments can be just as damaging - beware the chimera of silent anger as much as explosive anger.  The goal is to find true resolution of differences and mindful ways of conduct with spouses and children that ultimately leads to greater intimacy and thus, greater joy. 


Saturday, September 26, 2020

The Lowest Hanging Fruit


The Lowest Hanging Fruit


This most unusual COVID period brings unheard of amounts of social isolation, worry for ourselves, our families, and the specter of quarantine in homes that seem to shrink the longer we are secluded.  These are challenges not seen in over 100 years.  It’s a perfect recipe for irritability, loneliness and sadness  - we’re hard wired for the social contact that’s dangerous right now.  The emotional cost is high, and as it affects you, it affects your loved ones.  One solution to these challenges has been documented for decades:  Aerobic exercise.  And the “lowest hanging fruit” in the exercise arena is, for most, brisk walking.  Yup, it can be that simple.

Researchers have repeatedly documented the mental health benefits of aerobic exercise.  A July 2020 Harvard article reports, “Exercise reduces levels of the body's stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, chemicals in the brain that are the body's natural painkillers and mood elevators.”  Please re-read that Harvard quote.  Exercise results in less stress and a better mood.   That’s a lot these days.   

If you’re now putting on your walking shoes, put this down and go.  If not, read on. 

The practice is simple: 30 minutes of aerobic exercise per day, 4 days a week to produce the benefits mentioned in the Harvard study.  The definition of “aerobic” is an elevated heart rate.  Few of us spend 30 minutes non-stop paying tennis, basketball or pumping iron, thus, they don’t check the “aerobic” box.  Running swimming or biking are the other activities that can provide us with the needed half hour – provided you have the equipment, inclination and skill.  Is it boring to you?  Plug in your favorite tunes or listen to a book, or a podcast.  Walk on a treadmill and watch a show, it doesn't matter.

Change, however, is admittedly hard.  Trying something different is a critical skill we use when confronting a problem.  Edison reportedly tried 1,000 different filaments before finding one that created the lightbulb.  That’s a lot of persistence.  So whatever excuses or rationalizations you have that get in the way of exercise, consider them to be puzzles in need of a different solution.

And if you don’t like the heat, walk in the early morning or late evening.  Unless your physician forbidding you from exercise, you’re likely eligible.  If you can’t walk briskly for 30 minutes comfortably, that’s proof that you need to work up to it. 

There’s nothing to lose trying it out for a couple of weeks, which is as long as it takes for the benefits to kick in.  And don’t forget – kids need this neurochemical support as much as anyone else.  They’ll not likely jump at the chance to just “go out for a brisk walk” so find ways to encourage them.  Walk with them, take them somewhere they can ride their bikes for a half hour.  Reinforce their participation with praise and whatever treats they like that you can live with.  It’s a challenging time.  Meet the challenge. 


Friday, April 17, 2020

COVID 19; It's Simple, Not Easy

I have always valued the phrase "simple but not easy."  It captures so much truth.  (As with all posts, materiel identifying information is changed to shield client privacy.)

I met with a young woman I'd not seen in about a year.  She's in college and doing well.  Quite well. She's found her area of expertise and has been excelling in it.  After we spent some time catching up and her sharing how well things were going, I inquired why she contacted me. 

She shared she had a major presentation of a paper she'd developed and spent a great deal of time.  She had  been chosen from many applicants to present at a prestigious conference.  She was in the early stages of hitting her professional stride in college, which is indeed an accomplishment.  She admitted she'd been a bit wishy washy about academics after her transition to college.  She responded by finding her bootstraps and pulling hard on them and has begun to see objective success that, with this conference, was about to put her in very good stead as her career developed. 

Her acceptance to present at this conference was a major validation of her efforts, her gifts and her accomplishments.  It's cancellation due to the CV 19 concerns that the world currently faces has deeply deflated her momentum regarding her identity as a professional. 
I suggested to her that she's facing a couple of things that many of us are coping with:  She's not in control of what happens, and bad things happening to good people. 

Her diligence at her academics had been totally in her control.  Even though she was surprised at being chosen to present at the conference - she had read the other submissions and found many of them to be quite impressive - she was learning that she could earn the right to be counted among the highly accomplished in her field.  Her academic gifts notwithstanding, she'd done the work.  She'd put in the hours, listened to her professors' advice as she progressed.  She was in charge and responsible, and she was enjoying that sense of authority over her subject matter and the recognition that was coming with it.  And now she's understandably struggling with the cancellation of the conference. 

She'd done all the right things, is active in her community, was raised in a loving family that has encouraged and supported her throughout her years.  She's active in her church, she volunteers.  And was confused at why something like this might happen to her. 

We discussed the realities of not being in charge and being victimized by the seeming randomness of life in this universe.  I encouraged her to consider that such is the lesson we all have to learn, sooner or later, whether dealing with a global pandemic or a fender bender.  The lessons of living life on life's terms, where we are not in control, despite our efforts, despite doing all the right things is a simple reality.  Absorbing those lessons, digesting them, integrating them into one's conscious rhythm, that's not easy, but is the task at hand.

Wednesday, October 30, 2019

How Much Academic Pressure Do We Put On Children?

While speaking with a family recently, I learned that their middle school child was on an advanced academic track.  In middle school.  This child was not struggling at all with the content, but his behavior at home was atrocious.  This same family told me that the advanced programs were soon going to begin in elementary school.  In 3rd grade.  It was all I could do to not scream

There are lots of smart, high achieving and financially successful folks out there, and they, not surprisingly, have a lot in common with one another.  So also not surprisingly, they marry.  In the long list of what's logical, they have children, and those children may be, smart.  Quite smart.  I often see some very smart kids (both on the autism spectrum and those who are neurotypical) who are bored with school.  I often say that there's nothing tougher than a really smart kid with ADHD.  A smart, bored kid in a classroom who's unable to manage their impulses is often a real challenge.  And even if the child is smart and not a behavioral challenge, do we not want to afford them every opportunity to maximize their potential and strengths?  Well of course we do.

I know of one child who had learned to count in mid elementary school.  In base 8.  That's where 8 is a round number like 10 and if you want to know more about that, google it, because the last I learned it was over 50 years ago and it didn't really stick.  But this kid got it.  Before middle school he was doing algebra.  Well.  He's an awfully smart boy.  And, again, no surprise, his parents are really smart.  They worked hard to get him involved in enrichment programs in math so that he could excel in the areas he found naturally strong.  They did it on their own, outside of the regular curriculum.  It cost them money and time.  It was inconvenient.  But I think they made a wise choice of leaving him in his regular classroom, asking the teachers to provide him some enrichment so his boredom didn't turn into disruption.  His elementary school didn't have an advanced track and they, wisely I believe, didn't transfer him to one that did.  And I think that's OK for younger kids where their social development is so critical. 

On the other hand, what's the cost of so many advanced classes and advanced expectations?  Unfortunately I see lots of really smart kids (yes from really smart parents) who perform quite well, even when lots is asked of them.  They're smart, after all, so taking the AB classes and the AP's is within their academic reach.  It is not, however, always within their emotional reach, and this is my concern. 

So many of these adolescents are used to high pressure that by mid high school they've burned out.  They begin to learn to game the system, so they learn as much about what they do/not have to do to get the grade as they do about the content of the class.  Some excel in two areas: academics and anxiety.  They worry that they're not good enough, even when obtaining good grades, because they've known only pressure for years.  Others begin to have existential crises.  In high school.  They contemplate what the broader meaning is of these hoops they've been jumping through.  Sometimes, sadly they become depressed and suicidal.  Now I love philosophy and the self examination that comes with it, and I think high school is a decent place to do that.  But is the angst, the depression and anxiety that comes with it worth the cost or risk? 

And these kids don't only excel academically.  They become involved, very involved in their extra curriculars.  The scouts eye becoming Eagle Scouts - earlier and faster than their peers, because competition is embedded in the social culture of achievement.  The musicians need lessons, from the local symphony's professional musicians and compete for regional, state and national performance opportunities.  They compete in debate.  Nationally, not just locally.  Children's soccer, softball and little leagues have after season travel teams that demand more and more time (not to mention money from parents) to excel.  Middle school parents discuss sports scholarships in front of their children.  How much pressure do we want children to have? 

There must be a balance to strike, and I wish I had a brilliant balanced hand to guide in suggesting one.  Kids should be encouraged to work hard.  They should be allowed to follow their natural talents.  I also think they should be allowed, and encouraged to have down time (not screen time) with their peers in which they can be creative and even lazy.  I'm not extolling laziness, I'm suggesting that having time without the excessive expectations being placed upon them is valuable.  And there's a huge difference between adolescents who hunger for more and those who are told, from an early age, that if they don't excel for the purpose of attending a much better university, that their trajectory in life is at risk.  It's just not true, regardless of what their high achieving parents, school administrators, tutors or others may say.  It's time to reconsider the culture of never ending pressure and competition that we've created.  There is, after all, a lot more to life. 

Wednesday, September 25, 2019

How We're Minted: Growing Up With A Sibling With Autism

As in all posts, materiel changes are made in the descriptions to protect identity.

I was taught many years ago that often, people in the helping professions come from dysfunctional homes.  And I have found in my career that indeed, many nurses, doctors, mental health professionals have family histories that include challenges such as addiction, chronic illness, trauma of many kinds and the like.  Many, but certainly not all.

Later in my career I was taught that the siblings of children with severe medical, developmental or mental health problems often become caring and emotionally rich adults.  And I found in my career that this has often been the case.  I've met many siblings of kids I work with and other adults who have sibs with disabilities who are indeed, kind, sincere, hard working, earnest and the like.  Those traits, that experience can lead to great inner strength and self confidence. 

This is true for many, but not all.  Susan's a college student who has a younger brother with moderate autism.  Her brother (and her family) struggles with his rigidity, his narrow emotional capacity, his frustration with his understanding that he has autism and his depression that he's not "normal."  They have dealt with her brother's behavioral challenges and Susan was always expected to help out, to accommodate, to help when asked.  And she did, faithfully.  She understood that her brother couldn't help having autism.  She saw her parents' struggles with him and tried whenever she could to pitch in to help.  Her parents appreciated her efforts on their and her brother's behalf. 

Now in college, Susan has been struggling with significant that anxiety that can be almost paralyzing.  It started as small worries when she was helping out with her brother, the tension in the home such that if things went wrong, someone was likely to yell.  Likely her brother, not infrequently her mother, less frequently, but sometime, her father.  And with the yelling came the sharp sense of responsibility that has grown, now all but out of control. 

She can't decide what to do or concentrate on her academics for fear of getting them wrong (despite that fact that by doing so her grades have indeed suffered, adding to the spiral of anxiety.)  Her social life is flat.  She won't go out when asked, fearing that anything and everything might go wrong.  She might say something wrong or do something wrong.  He probably won't like her anyway.  She's not pretty enough.  All the classic low self esteem stuff that is not at all consistent with what I learned about siblings who have significant disabilities and, as adults, flourish.  Susan's not flourishing.  She's deeply stuck.  She's fears doing all of the normal things that folks with anxiety benefit from, whether it's exercising regularly, learning simple meditation, reading materiel that can help, calling a doctor for medications. She's ambivalent about therapy as well. 

So when speaking with her recently about a problem she was having with a friend, where she was besides herself fearing she would hurt her friend's feeling with a very reasonable request, I asked her where she learned that her needs always came second to those of others.  She shrugged.  I asked her what it was like for her when she was a kid dealing with her brother and whether his needs came first.  She stopped.  She teared up, the pain of bearing more responsibility then she could bear for so many years, of worrying about whomever might yell next. 

And I showed her an ancient coin that happened to be on my desk.  The coin is a couple of thousand years old and has the look that when struck, the stamp that was used was just off center, as is common with such antiquities.  It has quite the imperfect look.  And yet, from the moment it was struck it was legal tender, as valuable as any. And I showed it to her, noting the imperfections of the coin.  Imperfections that reflect those that each of us may have, whether it's struggling with anxiety or depression or abrasive personality traits or whatever other imperfection we may have.  We've all been "struck," like the coin, by the cumulative events of our history.  Nobody really comes through the crucible of childhood unscathed.  Some of us may wear better than others, but we all carry scars of one sort or another.  It's OK to be who you are, whether the scars are large or small, whether you cope well or struggle with coping.  The key factor is to understand that, as the ancient, poorly struck coin, your value is exactly equal to whomever might be standing next to you.  I hope Susan hears that.