Fitting to repost the #1 blog by Eshrink (my dad) about Mrs. Eshrink (my mom) on this Valentine’s Day. Click the link below.
Advice
How to Survive Loss
Life can be defined as a finite period of time characterized by continual change. Consequently, since nothing is permanent, we all experience losses. Some are trivial, others are devastating. We are now living in a time of great turmoil with millions of people subject to losses beyond their control. Thousands of homes and businesses have been destroyed by the effects of climate change with fires, floods and storms throughout the world. Many more have been displaced by wars and political upheavals with thousands having lost their homes, possessions and way of life, but the most immediate and tangible threats are due to the COVID-19 pandemic where in addition to the loss of over a quarter million lives, several million remain unemployed, and self-imposed isolation has taken a toll on mental health.
According to the CDC, 8 out of 10 deaths from the virus have been in those over age 65, but they noted even those in their 40s and 50s are at higher risk than younger folks. Many studies have documented that widowhood carries with it a mortality rate of well over 30% during the 1st 90 days of bereavement and 15% thereafter, powerful evidence that loss of loved ones has serious consequences for survivors. The pandemic has limited traditional mechanisms of dealing with grief since last goodbyes are often denied due to isolation policies, and funerals, wakes, and life celebrations are limited. Time will tell if their lack will result in an increased prevalence of unresolved grief.
Grief | Loss due to death vs Loss due to breakup
Meanwhile, we are still subjected to the ordinary losses associated with the process of living. Much of my time as a psychiatrist was devoted to helping those afflicted with the pain of losses, as I am sure is true for most clergy, counselors, social workers, psychologists and bartenders, etc., but it is only recently that the Board of directors of the American Psychiatric Association has recommended that unresolved grief be considered a diagnostic category. Although death of a loved one may seem the ultimate loss, in some ways it is easier get over than the termination of a relationship via other means, such as divorce or breakup of an important personal relationship. The finality of death encourages one to move on, but when the object of one’s affections is alive a relationship real or imagined will persist. Thus, Don Jackson, a renowned family therapist said there is no such thing as divorce. Or as I have often said: divorce is like a death in the family, but you can’t bury the corpse.
Our nature requires relationships. Relationships help to define our identity, i.e., who and what we are. For example, I am often introduced as Barb’s husband which provides considerable information about me. Our identities are also shaped by those with whom we associate even the organizations to which we belong or those we choose to lead us. Long term relationships invade one’s personal space to the extent that we often absorb some of the involved person’s personal characteristics to the extent that they become part of who and what we are. Consequently, their loss may result in what I call a psychological amputation. Thus, in the face of such losses, one is left with the feeling that a part of one’s self has been taken away.
As with the loss of a physical body part, a psychological amputation can result in myriad feelings and reactions in addition to sadness. There may be anger, at times even rage, directed to whomever one blames even him/herself. Instances in which rejected suitors have stalked, assaulted, or even murdered, are unfortunately not rare, which naturally leads one to question the nature of such alleged love. There may be feelings of betrayal at the deceased for being abandoned or for behaviors thought to have hastened his/her death. God is often a target for anger, especially in deaths, and in such instances the Biblical quote: “the Lord giveth and the Lord taketh away” rarely provides solace. Although I have found that referral to the patient’s pastor or Rabbi is frequently helpful.
GUILT
Anger may also be self-directed resulting in guilt. In such cases, the patient may spend endless hours ruminating over what he might have done to prevent the loss or even worse how he could have caused it. A close friend of mine, who shall remain nameless, continues to have pangs of guilt over her Grandmother’s death nearly 80 years ago because as a child she had “sassed Grandma” shortly before her sudden death.
There are instances in which survivors may feel guilty for not grieving enough. One case from many years ago, which has stayed in my mind, involved an elderly lady who was referred to me by her family doctor with the complaint that she had lost the strength in her right leg. An extensive workup had not yielded a diagnosis and the referral appeared to be a hail Mary. She walked into the office unassisted. Although using a cane, she appeared to walk quite well. Her story was that her husband of many years had recently died following years of a debilitating illness for which she had been his primary caregiver. She reported that she rarely left the house during all that time, having obviously taken seriously the vow about “in sickness and in health.” Shortly after her husband’s death, she was excited to visit a friend in a neighboring village whom she hadn’t seen since her husband became ill. After starting her car, she was unable to move her leg to the accelerator in order to drive away -a classic case of conversion reaction, resulting from the guilt she felt over enjoying her new found freedom.
The Affect of Death on Children’s Development and Attachment Theory
It has long been noted that children who become orphaned are at risk for significant relationship or mental health problems later in life. (This is a relevant post from Psychology Today). Konrad Lorenz’s studies of imprinting demonstrated the importance of relationships in young animals, and Bowlby, with his Attachment Theory, came to similar conclusions regarding humans. When the process of attachment is interrupted prematurely it may leave the child lacking in skills necessary to develop healthy relationships, and leave them impaired for life.
Much has been written about the stages of grief. However, I have not found that concept particularly helpful, for in my experience people do not always follow a particular pattern of behavior when they have lost something or someone, though I have found that denial is frequently present especially when the loss involves another human life. Although at a conscious level there is realization that a person is gone, a survivor may behave as if expecting them to return. In such cases there are frequent slips in which the deceased person will be described in the present rather than the past tense. There is resistance to disposing of clothing and other personal effects, or to removing the voicemail greeting from the family phone. Frequent trips to the cemetery are common and may involve imaginary conversations with the deceased. The survivor may be said to have “held up” surprisingly well during the burial proceedings.
Perhaps, the most painful loss of all is the death of a child, and in my experience the most likely to result in denial. Although at a conscious level the parent knows their child is dead, they may continue to insist that their room will remain untouched as if they are waiting for him/her to return. Deaths by suicide usually introduce a series of unanswered questions which further complicate the healing process, often leaving survivors blaming themselves.
It goes without saying that it is very difficult to resolve a problem without acknowledgement that it exists, and in my experience, denial following the death of a loved one is quite common. It is usually the first hurdle that must be overcome in order to find resolution of grief. There are numerous exercises which may be ordered to help one achieve acceptance. My favorite is to arrange a visit to the graveyard with a close friend or pastor, simply say goodbye, and have a good cry. For those in denial, there is usually a great deal of resistance to using that word, and the mere suggestion to carry out those instructions is often met with tears.
Loss of Relationship by means other than death can be even more complicated.
The break-up of young lovers, especially first loves, is complicated not only by the level of passion involved, but their lack of experience in dealing with loss. They should be taken seriously as such losses can result in serious suicided attempts especially in teenagers. But for anyone the loss of a love object can be devastating for with it go dreams of an idyllic life with the hope of loving and being loved. It may result in sadness, depression, anger, or even violence.
How to Survive Loss
Hope is invaluable with the loss of things which are replaceable for it inspires one to action. The streets of our big cities are littered with homeless people most of whom have lost hope, while those who have lost their homes in fires or other calamities, although saddened and depressed by the loss of all their possessions, need hope if they are to replace that which has been lost. However, with abandonment by a loved one hope can hinder resolution. It goes without saying that one cannot live in the moment if they are stuck in the past, which happens when we continue to dwell on recovering something which is beyond reach.
Recovery from loss is simple but not easy.
We must “let go” if we are to “move on.”
We let go by grieving. Grieving is the process by which we allow ourselves to grapple with and purge intense disabling emotions following a loss. Grief can be initiated by the loss of anyone or anything to which a person has a personal attachment.
Cultures have developed various traditions which seem designed to promote resolution of grief following deaths. In a previous blog I have written about those I experienced in a rural midwestern village 75 or 80 years ago, but my favorite funeral celebration is the traditional New Orleans jazz funerals in which the funeral procession is led by a brass band to the graveyard while playing a funeral dirge, then following interment the band marches back toward the decedent’s home playing a lively Dixieland tune. The message could not be more evident. There is acknowledgement of the sadness of death followed by the celebration of life, a perfect example of letting go and moving on.
Other Types of Loss
In addition to the loss of loved ones, since the word pandemic entered our lexicon, we have been subjected to losses of some of our most precious possessions. It has been said that you don’t fully appreciate the importance of something until it is gone. Granted, it has been catastrophic for those who have lost jobs, housing, or businesses, but the isolation and cumulative effect of the loss of activities which we previously would have considered mundane have also taken a toll.
On a positive note, if there is one, perhaps we have learned to know the value of some of those things we previously took for granted. There is also hope that constriction of our social activities may result in more family cohesion. Who knows? Maybe kids and parents will even start talking to each other. Losses of all kinds are bound to get our attention, and there is often a lot we can learn from them, especially those we create by our own mistakes for failure is the great educator.
CATHARSIS
Although in rare instances, loss may result in a sense of relief, in nearly all cases, there will be strong feelings elicited as previously mentioned. Such emotions are disabling and must find expression, a process which we call catharsis. It is not a good time to do the strong silent thing when consumed by grief.
As I have mentioned many times, we are herd creatures, which is hardly a new concept having been the subject of John Donne’s poem, “NO MAN IS AN ISLAND” written in 1624. As such, we are dependent upon others whether we like it or not. In the face of intense emotions we can become overwhelmed and confused. In such times more than ever, we need validation, i.e., someone who we trust to listen, be supportive, and reassure us that our feelings are rational. Indeed, the process of attempting to communicate those feelings verbally helps to organize one’s thoughts, and a recent study in the American Journal of Psychiatry, has confirmed what we already knew, which is that confiding in others helps prevent depression. After all, that is how I made a living.
Surviving Loss is a PROCESS
Usually catharsis is not a one-time thing and there will be triggers that will resurrect some of those feelings in milder form from time to time, but most will learn to let go of past traumas by focusing on the road ahead. Hopefully, they will come to understand that to look back over their shoulder will likely cause a stumble, and that they must let go of the past in order to move ahead.
With millions all over the world facing serious losses, we are not only “all in this together,” but we are also very much in need of each other and there has never been a better time for us to be our “brother’s keeper.”
‘TIS THE SEASON $$
Introduction from Eshrink Editor: I think all readers will relate to this blog post where Eshrink discusses the battle of the charities during the holidays. I told him about a website I use to evaluate charities and he wanted me to add it to the beginning of the post in hopes it might help people give to charities that maximize the amount of money that goes to the people the charity says it wants to help versus executive compensation and “administrative” costs. It’s charitynavigator.org. What I like about this non-profit is that they explain in simple terms the methodology they use to evaluate each charity. Take it away Eshrink with the latest installment of the Curmudgeon Series. This one is entitled ‘Tis the Season!
Now is the time to max out those credit cards. After all, you will have a year to pay them off, and be ready to do it all over again. Most people, even some non-Christians, follow the tradition of gift giving during the Christmas holidays. Some might say that in many instances it has become an obscene example of crass materialism. In any event it is said that we of the Christian faith are generous in general, with of course, many exceptions to that rule. This generosity presents many business opportunities particularly in the retail and the manufacture of stuff. This is confirmed by the long-held proposition that the period between Thanksgiving and Christmas is the only profitable time of the year for many retailers. There are also the delivery services, the credit card companies, the grocers, and the electricity providers that are among those who profit as a result of those millions of gaudily wrapped packages.
JOY TO THE WORLD
Ah, but those are not the only ones for whom the season is joyous. It is a great time for thieves who can follow UPS or Fed Ex trucks and collect a lot of stuff, not to mention the shoplifters and purse snatchers who find it easier to defeat the security cameras when stores are crowded. The “begging” business is also certain to have an uptick since there is a focus on family and children, and the contrast of opulence and poverty is apt to be dramatic–thus provoking feelings of guilt among those who go “ALL OUT” on the gift giving at Christmas.
TIME TO CASH IN: THE BUSINESS of GIVING
Those circumstances are not lost on various charitable organizations who go into high gear during the holiday season. The Society for the Prevention of Cruelty to Animals unleashes some real tear jerkers on television. The Shriner’s Hospital, and St. Jude Hospital for children likewise are not shy about showing children in wheelchairs or with prosthetic limbs. There seems to be an increase in the number of starving children seen on TV along with severely impaired veterans leading one to assume there must be considerable competition for all that Christmas “goodwill” money. Charitable giving is also enhanced by those who want to take advantage of deductions prior to the end of the year. It is fertile ground and must be the charitable organizations’ equivalent of the retailer’s Black Friday.
DISCLAIMER to IMPENDING COMPLAINT
All of this is simply a preamble to my most recent complaint. In my defense, I feel compelled to issue a disclaimer that I am not anti-charity in any sense of the word. As a matter of fact, I believe that it does good things not only for the beneficiaries but often times even more for the giver. In my own case when I am feeling particularly beneficent, and drop a whole dollar bill in the Salvation Army pot, which is obviously designed to only receive coins, I walk away with a bit of a spring in my step feeling very righteous.
NO ANONYMOUS DONORS
Although I do not profess to be even a minor league philanthropist, I do manage to cough up a few bucks on occasion for charities which I think worthwhile. In recent times, we as a society have chosen to forfeit privacy in return for convenience. Consequently; it should not come as a surprise when organizations sell our names to other organizations. In one case I noted a very small print notice in the bottom of a solicitation that reassured me that although they passed my name to other charities, such organizations were carefully vetted to ensure their legitimacy. Somehow, I did not feel motivated to thank them for deciding to put my name on someone else’s sucker list without my permission. Since this seems to be standard operating procedure for these charities, it is not surprising that our gift giving is rewarded with a barrage of requests for money.
GOOD STUFF for “FREE” – NEW TACTICS
In recent years I have noted a new technique designed to squeeze some green from our pocketbooks which I find to be especially repugnant. I first noticed this several years ago with a solicitation from the March of Dimes. Some of you young whippersnappers may not know that this charity had its beginning as a quest to find a cure for Polio, but with the eradication of that disease, they didn’t want a good bureaucracy to go to waste so they switched to birth defects. Those of you who are on their list may have noticed a dime is attached to their fundraising letters.
I do not mean to denigrate the March of Dimes organization for they were very much involved in financing Salk and Sabin who developed the vaccines which eliminated that horrible disease that left children crippled for life. It was developed in 1938 with the help of Franklin Roosevelt, himself a victim of the disease. I recall fund drives at our school when we kids brought in dimes to be used for the cause. Of course, this was back in the time when a dime had some value, a time when the dime stores flourished and you could actually buy something for 10 cents. In addition to the financing, it provided for research. I am certain it also had great value in allowing kids to feel good about giving.
NOT A PENNY FROM ME
Although the March of Dimes pioneered this type of fundraising, others have carried the idea of sending a gift with their solicitation to a ridiculous extreme–which is the basis of the weekly complaint from this old curmudgeon. The dime was merely a symbol, while all the stuff I see arriving along with an essay concerning the plight of those who suffer from some horrible malady or situation, is accompanied by greeting cards, return address labels, ball point pens, calendars, calculators, and even money. The latter are the ones that I find most irritating. They apparently think that if they send me a check for a couple of dollars, I will feel obligated to send them money, which of course makes even less sense.
If these fund raisers in their infinite wisdom believe such tactics stimulate me to contribute to whatever they are selling, they are sadly mistaken. Instead, I feel insulted that they think they must give me something in order to get something from me, or is it that if I get something for free I will feel guilty if don’t respond. In either event, response to such tactics is unlikely to put that spring in my step.
The whole “tactic” just puts a damper on that feeling of goodwill that should accompany generosity. What’s the answer? Well, you could write a blog post about it (or let these charities know what you think by writing them an email or strongly worded letter). Also, Eshrink editor Maggie provided you with that charitynavigator website at the beginning of this post. ‘Tis the Season of Giving. Give wisely!!
CAN’T WE ALL JUST GET ALONG?
It has been 27 years since Rodney King, an alcoholic drug-addicted Los Angeles cab driver, tearfully uttered those words. Rodney was a troubled soul whose beating by police officers was filmed by a bystander and precipitated the L.A. race riots which resulted in the death of 63 people, hundreds of injuries and massive property damage. The answer to Rodney’s question remains moot, for we are still not getting along very well. Perhaps we need to spend more energy on learning why this is still true.
REAL CHANGE OR WINDOW DRESSING?
It is true there has been progress in race relations, the issue of police brutality is being seriously addressed, and the “metoo” movement has garnered some traction, but we continue to expend a great deal of energy in fruitless debate which never seems to find resolution. This is especially true in our current political scene where vituperative language has become the norm, and both democrats and republicans cling so rigidly to their positions that compromise is impossible. Disagreements have become personal. Name calling and character assassinations are routine.
A PERFECT STORM
Not since the civil war has there been so much divisiveness or tribalism as is the currently fashionable term. It appears to me that there are multiple reasons why we can’t “all just get along,” one of which is the nature of our political campaigns. Somewhere along the way experts in such matters determined that so-called negative campaigns are the most effective strategy, and that has become the modus operandi for all kinds of kinds of candidates from dog-catcher to president. With the candidates continually trading insults and accusations, there is little relevance paid to issues and the undecided voter is left to decide which of the candidates is worse. Since his vote is based largely on his disdain for the character of his hero’s opponent rather than issues he is likely to retain very negative feelings towards the one whom he voted against. Such feelings may be carried forward and make it more likely that when a discussion ensues between two on opposite sides of an election civility is less likely.
NEWS. ARE YOU KIDDING?
So-called cable TV news stations have also in my opinion contributed to this giant schism in our political discourse. I use the term so called for they can hardly be called news outlets, but are dominated by political commentary to be generous or perhaps more accurately political propaganda outlets. Fox News leads the pack with the most viewership and the most conservative commentary. Their current star Sean Hannity is said to be one of Trump’s most trusted political advisors yet they have the temerity to call themselves “Fair and Balanced.” At the other end of the political spectrum is MSNBC who no longer attempt to hide their pro democratic bias. Then comes CNN which makes a pretense of being neutral, but fails miserably. They do have some conservative consultants on their staff which they bring in on occasion for their group discussions.
WHERE IS THE MIDDLE?
One thing these networks have in common is their programming which consists mostly in bringing in groups of experts (there must be a lot of experts in Washington for they never seem to run out) and have a group discussion with participants representing more extreme positions on both sides of an issue. Consequently; a viewer is likely to choose a more radical position. The days of political reporting in which both sides of an issue are elaborated upon by a single person with no skin in the game seems to be long gone. Only PBS seems to follow that old-fashioned format of simply presenting the facts and allowing the viewer to draw his own conclusions.
GROUP THINK
During my career as a Psychiatrist my patients taught me much about our desire or perhaps more accurately said our need for validation. As such we are inevitably drawn to those who share our beliefs and perceptions, and therein lies the effect of today’s dueling media outlets. Those of us who harbor conservative beliefs will be drawn to Fox while the more liberally oriented will stick with MSNBC or CNN, “and never the twain shall meet”. The same phenomenon is operant with “talk radio” and with the internet which is becoming a news source for increasing numbers of people. As we continue to be immersed in one particular viewpoint and converse only with people of like mind we find ourselves rigidly attached to one particular political philosophy having convinced ourselves that we are the only custodians of truth.
LOGIC BE DAMNED
An argument can be defined as a person or group attempting to convince others that they are wrong. It is also true that political issues can have serious consequences therefore; political arguments can and often do become emotional. I recall as a child hearing the admonition that one should avoid discussions of politics or religion in polite company, and indeed these are the two subjects about which people are likely to have the most intense feelings. Since I am a peace-loving man and something of a wimp to boot I must admit that I tend to shy away from raising the issue of politics with friends whom I know to be on the opposite side of the fence. I submit that this same phenomenon exists throughout society and deters us from discussions of the issue that divide us and hopefully learn to compromise or at least respect the opinions of those with whom we disagree.
Advertisers have long proven that repetition in TV ads will sell everything from Viagra to Tylenol, so why not politicians. The Washington Post reports that $6.5 billion dollars were spent on the 2016 election much of which undoubtedly went to television ads leaving us drowning in a sea of powerful messages describing how terrible are all those candidates for office. Little wonder that elected officials now share the worst favorability ratings ever, and that disgusted citizens are so sickened they don’t even bother to vote.
BAD GUYS EVERWHERE
Among the most powerful motivators are anger and fear, and those masters of propaganda who manage elections are adapt at using them as weapons. Naturally when one votes for a person because he is persuaded that the other candidate is a threat other issues will become irrelevant adding more fuel to that fire which inhibits reasonable discussion.
Our prevaricator in chief has proven himself to be a master at eliciting those feelings and continues to describe the press as “the enemy of the people” and members of the Democratic party as “evil”. There are also the warnings about immigrants characterizing them as criminals, rapists, murderers, drug dealers and subversives. His talent for instilling such feelings is well demonstrated by the behavior of some of the attendees at his rallies. History shows us that a very effective way to unite a group of people is to find a common enemy, and his followers revel in chanting “lock her up”.
THERE REALLY IS “FAKE NEWS”
Last but certainly not least is the effect of the internet and social media which held such promise in bringing people together has now become a powerful weapon to interfere in our elections primarily by propagating conspiracy theories and lies of all kinds so numerous that it is virtually impossible to rein them in. Artificial intelligence has further sharpened these tools so that individuals can be targeted with false information tailored to their own particular biases or prejudices, and can reach millions of people in short order with very little expense. Nearly everyone except Mr.Trump agree that the Russians were very involved in such shenanigans in our last election and although we are told the effects on the election cannot be determined there is little doubt that it has contributed to much confusion and misinformation designed to enhance our divisiveness.
WISHFUL THINKING
The other day when I began writing this I thought there were signs of at least some yearnings for a coming together to work out problems. Niki Haley in her retirement announcement appeared to break from her boss and indicate that she did not think political opponents to be enemies. There was commentary on our need to come together, but those hopes were soon dashed with the pipe bombs, and now the senseless shooting of 2 black people in Kentucky followed by the mass murder of Jews in Pittsburg.
SOME BEHAVIOR IS PREDICTABLE
With such horrors filling the headlines you might think they would provoke serious talk about bridging the now toxic divide that separates, but after expressing regrets and sympathies yesterday our fearless leader is back on track today blaming the news media for causing the tragedies. Apparently, the false flag theory which named the Democrats as the perpetrators didn’t fly so he was forced to go to his fall back strategy. Nevertheless, we once again hear talk of our need to come together in spite of our differences. Will we follow through this time? Hope springs eternal!
Transitions
This title was chosen by my son for reasons which will soon be obvious. His youngest has just left home, this time for good, and he and Sue are now presiding over the proverbial empty nest. It is a frequently quoted truism that if you truly love someone you will let them go when it is in their best interest to leave. I was reminded of this last night as I watched Casablanca…one of my favorite movies in which that theme was paramount. Though it is a noble act to let go of those you love, separation is painful, and usually results in significant changes in our lives.
We experience multiple types of transitions during our lifetimes, but since we are at heart social beings, or to put it more crudely, tribal in nature, changes in our relationships are apt to generate the most intense feelings. It is something of a paradox that as the world gets smaller, we find so many people of whom we care to be geographically farther away. Yes, indeed we are able to communicate with ease yet Facebook is a rather poor substitute for a next-door neighbor, or a relative living in the neighborhood. Prior to the industrial revolution, one’s cadre of friends and relatives was unlikely to change very much, and most people were born and died in the same place, often even in the same house. Now neighborhoods are in a constant state of flux, and there is a lower expectation of lifelong relationships.
STUCK WITH THEM
No wonder our children are among the very most important people of our lives. Since humans require nearly 2 decades to reach maturity and carry our DNA, we tend to form very strong bonds. We are often identified as “Johnny’s” father or mother. We live vicariously through them and share their triumphs, failures, joys, and sorrows. In many ways they are our second chance at life as we attempt to steer them away from repeating our mistakes. As the years go by our intimate involvement in their lives blurs with our own–they become part of us and in doing so shape our identity, i.e. who we are.
GRIEF WITHOUT A CORPSE
With all that in mind, it is not surprising that separation anxiety is a common affliction. When the kids grow up and leave, something more than their presence is missing. It is as if a part of ourselves is gone. Not only is the nest empty, but we feel an emptiness within ourselves, a kind of psychological amputation. In my experience, this emptiness is most profound when the youngest one leaves for with it comes the realization that nothing will ever be the same. This time they are leaving to build their own nest.
THE FUN TIMES
Life is an ever-changing process. We begin as totally helpless and dependent creatures and experience a myriad of transitions during our lifetime all designed to produce an individual capable of building and presiding over that nest. Some of those changes are more dramatic than others. There are the first steps, the first words, the first solo bicycle ride, the first day of school, the first sleep over and a few thousand other adventures all with a goal of achieving sufficient independence to allow them to face the world on their own.
WHY DID I GET INTO THIS?
But it is not all sweetness and light. There is the messiness, the lack of discipline, the terrible twos, the out of bounds phase, the adolescent rebellion, the sleepless nights, and the continued testing of limits to name a few of the frustrations inherent in the child-rearing business. Those little buggers are also expensive. According to the USDA the average cost of rearing a child in 2016 was over $245,000 which does not include costs for higher education (but for the kids, I could have been a millionaire). Considering all the chaos they generate it is little wonder that we don’t occasionally wish them to be grown up however; one should keep in mind the maxim to “be careful what you wish for.”
BEGINNING AND END
According to the Bureau of Labor Statistics 67.3 % of high school graduates enrolled in college last year (2017). It seems safe to assume that most of these kids would leave home while in school, but retain a close connection to their old familiar environs. In many cases the college transition is a prelude and training for that final fly away. The days when we dumped kids and their gear off to a strange new environment were certainly memorable to Barb and me.
Our first experience with the off to college scenario was painful for all involved. Molly, our firstborn (now deceased), who suffered from serious medical and emotional problems was unable to complete that transition. Next in the line of succession was Peter, who was much too macho to display his feelings, but I was already missing him by the time we pulled away from his dorm. After a four-year hiatus, it was Trudy’s turn. Trudy, the adventurous one, was on the phone almost immediately, tearful and very upset to find beer being consumed at the sorority rush parties that she attended. We had no idea where this came from for temperance had never been emphasized at home. As you probably already suspect. her distress was short lived and as was her habit she soon became involved in everything.
THE LAST ONE STANDING
Of course, those separations were painful, but none so telling as Maggie’s departure for we were now returning to a house inhabited only by Barb, myself and Grover the dog. Maggie was one who had insisted on an out of state school, for she was eager to assert her independent status. She wanted distance from childhood connections. Her reaction to the college transition was a convincing testimonial for that “be careful what you wish for” thing. Permanently engraved in my memory is the sight of that sobbing, skinny little red-haired girl who stood there all alone in that huge empty parking lot making feeble attempts to wave goodbye as we pulled away. Barb wanted to go for one last hug, but I insisted she had already had several last hugs. We were later told that she cried for the next month and lost 20 pounds. [See an earlier blog post about Separation Anxiety + Mental Health}
NOT ALL SWEETNESS AND LIGHT
In case you are thinking this gang of mine is the Partridge family incarnate, think again. It is true that to date we have come through our transitions relatively unscathed, but not without trials and tribulations. In spite of their best efforts some families are overwhelmed by circumstances beyond their control. Barb and I are indeed fortunate that in spite of our screw-ups we have ended up with 2 generations of exceptional people, and the beat goes on.
STILL AT IT
It so happens that this month marks the beginning of significant transitions for every one of my Grandchildren which of course they will undoubtedly handle better than do their parents (or Grandparents for that matter). My three oldest grandchildren are already emancipated and starting new and more challenging jobs. Another is off to her first year in college, and our youngest is entering high school. As mentioned in my opening statement, Carter’s room is empty, and home is now in another city far away. Trudy’s is the only nest still occupied.
LIFE GOES ON
Whatever distress the kids may feel from leaving those years of memories behind is apt to be short lived compared to that of their parents. There is hope for Mom and Dad however. In return for enduring the vicissitudes of child rearing God has rewarded us with grandchildren. Thus, we have an opportunity to get all the goodies and none of the crappy stuff ,which leaves me wondering what it would be like to be a great grandparent. Stay tuned for the answer!
The Power of Belief
WHAT SHOULD I BELIEVE
A few months ago in a blog about conspiracies (May 2017, Conspiracy Theories) I attempted to find answers to the question of why so many of us seem willing to subscribe to stuff even when it is far from the truth, or in some cases totally illogical. The question has been of particular interest to me having seen many, many patients through the years with disordered thinking leading to false beliefs. The extreme example of the phenomenon is seen in the paranoid psychotic person whose perceptions are so distorted that his interpretations of reality are far enough removed from that of the average person that he lacks credibility. They are often so bizarre as to make others sufficiently uncomfortable that he may be shunned. As a matter of fact, it is not a stretch to describe paranoia as conspiracy theories on steroids.
ARE WE ALL A LITTLE CRAZY?
We now realize that there are many conditions that can impair brain function resulting in paranoia, yet when comparing the paranoiac to the conspiracist, we see they have much in common, which begs the question as to whether the paranoid’s extreme suspiciousness rather than qualitatively different is merely an aggravation of the basic human condition. After all, suspiciousness has been adaptive behavior for the human race. It has contributed to our survival and those without suspicions are called gullible and looked down upon. On the other hand, the conclusions arrived at by delusional thinking are rigidly held in spite of whatever logic or facts are presented. In like manner, the political zealot’s ideas seem set in concrete, and he brushes off contradictory information as either irrelevant or untrue.
THAT TRUTH THING AGAIN?
If suspiciousness is not only protective but in search of truth, why do we so often believe stuff when there is no evidence that it is true. Any good con man will tell you the best way to gain trust is to tell the mark what he wants to hear, and the best lies are those that confirm what he already believes. As a personal example, there is the case of Donald Trump, who I thought was a jerk long before his TV show. Granted, that opinion was based on feelings and maybe not even rational for obviously I didn’t really know him. Nevertheless, I am now even more convinced that he is a jerk and moreover a bad President. Consequently, I suck up what is said about Trump on MSNBC and reject what Fox News has to say as bullshit. I find it difficult to understand how some of my friends can listen to the Fox News bullshit, and I am sure they feel the same way about me and MSNBC bullshit. As a consequence, we rarely discuss politics, but I am sure that they talk politics to friends who are of like mind while I rap only with the anti-Trump contingent. Perhaps this is not such a bad thing. One study indicated that groups with opposing beliefs actually became more extreme in those beliefs while discussing the issues with those who differed with them. Thus, there may be wisdom in the maxim that “one should not discuss politics or religion in polite company.”
CATCH 22 AGAIN
Unfortunately, that policy presents us with another one of those unresolvable dilemmas, for if one assumes that it is impossible to resolve differences without discussion and discussion simply reinforces beliefs, compromise is unlikely to occur. The phenomenon does offer a measure of security to politicians or political parties in that limited exposure of their base to contrary ideas will keep them in the fold. With that, he can devote more resources to winning the independent vote.
When I was a kid we played a game called Follow the Leader in which participants were to follow the behaviors of the designated leader, and those who failed to mimic the leader were expelled until there were only two players remaining, at which point the one survivor would become the leader and the game would resume with the new leader. There is ample evidence that similar behaviors are seen in nearly all aspects of human behavior, and that we are indeed herd animals.
SO YOU THINK YOU ARE A THINKER?
There is a famous British study in which a large group of volunteers were asked to walk aimlessly around a large hall without talking to anyone, while a few were secretly given instructions as to where to walk, and to appear confident of their destination. 95% of the crowd followed those who appeared to know where they were going, in much the same manner as would a flock of sheep follow a Judas goat. This phenomenon, only one example of what has been called herd behavior or herd mentality, has received a great deal of study through the years by philosophers, psychologists, sociologists, economists, theologians, historians and even psychiatrists like Freud and Jung.
The principles of herd behavior, or tribalism, have been found to have great utility in influencing all manner of human behaviors. Indeed, it is difficult to imagine any aspect of our lives that is not affected in some way by our tribal memberships. Those of us who fancy ourselves to be independent thinkers have little awareness as to how these and other genetically ingrained behaviors unconsciously affect not only our behaviors, but our thought processes, opinions and beliefs. To belong, one must conform and conform we do, often with little awareness of why we do so.
HERMITS NEVER MAKE IT
The importance of herd behavior is not lost on the world’s politicians and despots. They know how to make use of our need to belong to a group or to use a shrink term to be “validated.” In order to brainwash someone or start a cult, one must begin by isolating the prospective victims in order to deny them validation so they will eventually align themselves with their persecutors. They make use of the fact that as herd animals, contact with other living things is essential, and they hope that their victims will eventually accept whatever relationship is made available to them. Similar dynamics undoubtedly play a part in the development of the “Stockholm Syndrome” as in the case of Patty Hearst, who joined the cause of her anarchist kidnappers after having been isolated and abused by them. As I mentioned in a previous blog, it has been shown in several studies that solitary confinement often results in the development of psychosis, further evidence of the importance of relationships.
JUST ONE OF THE GUYS
It is largely accepted as fact that negative political campaigning is more effective than merely focusing on issues. In such cases the emphasis is not on issues, but rather on his/her opponent’s character and identity. The candidate will set out to show that he is like his audience and thus is a member of their tribe while his opponent does not belong. When addressing a blue-collar audience, he may shed his coat and tie and roll up his sleeves. The recent election has demonstrated that a baseball cap can generate more votes than a resume in those rallies while more formal attire will be chosen for $1000-a-plate dinners.
HERDS GONE WILD
Nowhere is the herd concept better illustrated than at athletic events. I have been an Ohio State fan all my life, which by the way is a long time. Of course, football is the most raucous of all modern sports and one in which tribalism is on full display. I paid significant sums of money for the privilege of sitting in crowded uncomfortable seats sometimes in rain or snow. Surrounded by 100,000 fellow tribe members all rooting for the enemy to be vanquished, I felt I truly belonged. Fellow tribe members were readily identified by clothing adorned with the school colors. We pledged our fidelity by singing the alma mater followed by the school “fight” song. Seating was arranged so that the opposition fans were separate from us good guys, and the cheerleaders encouraged our totally uncivilized behavior. The best seats are those on the 50-yard line not only providing a better view of the action but placing the fan in the center of the crowd much as other herd animals jockey for position to be in the center of their herd. Our loyalties also affect our beliefs, e.g., questionable calls by the refs are bad if they favor the other team, and the boos of one are apt to be taken up by other fans.
In similar manner mob behavior can be initiated, and there have been instances where those officiating games have feared for their lives. Soccer games seem especially prone to mob behaviors. Political rallies can be orchestrated to take advantage of that same dynamic. It is said that Hitler frequently placed plain-clothed SS agents in crowds when delivering his tirades. Their job was to stir up the crowds by cheering his every word thereby stimulating herd behavior, a technique not lost on modern day political organizers. For example, it is clear that the “lock her up” chants during the last presidential campaign were not entirely spontaneous.
GOOD GUY, BAD GUY
Throughout history leaders have come into power by designating a person or group of people as enemies. A prospective leader must be able to place blame for whatever widespread complaint exists, and convince his audience that they are under assault by the bad guy or a group of bad guys. It is helpful if he can induce hatred, for passion increases voter turnout, and the resulting divisiveness is encouraged. An opponent will feel compelled to respond in kind to the accusations and the campaign becomes a battle of personalities rather than ideas. Charisma triumphs and meaningful debate never happens.
We are all under a great deal of pressure to believe as are our fellow tribesmen. Consequently, we are strongly influenced to share our beliefs with those who are sympatico, which often leaves us isolated from those who don’t share those beliefs. In a previous blog, I referenced a study which demonstrated that people are more apt to believe information obtained from a friend than from conventional sources, another indication that belonging is enhanced by sharing beliefs.
IS INDEPENDENT THINKING A LOST CAUSE?
Although many of our beliefs are buttressed by facts, there is also a certain amount of volition involved. We sometimes reject beliefs that we find objectionable in spite of significant corroboration, and readily adopt those we find appealing despite limited evidence of their validity. Religions demand professions of belief if one is to enter into the fold, be eligible for an afterlife or in some cases even one’s mortal life. Early Christians presented their captives with a choice of believing or dying. Radical Muslims are reported as doing the same even today.
Today, there are powerful pressures brought to bare in efforts to channel our beliefs. We are drowning in information, much of which is distorted or false. We are affected by advertising so sophisticated that it is personalized to each of us. News sources which we trusted to provide truths are under assault. Then there is that whole internet thing which muddies the waters even more. Perhaps it is understandable that in our search for a lifeline we should reach out to our tribe to tell us what to believe.
Addendum by eshrink’s offspring (Maggie)
So, what is the answer to this dilemma? Maybe recognition of our need to belong is the first step to evaluate our own ability to think rationally. Instead of convincing or attempting to persuade others, maybe more listening and less talking will lead to greater understanding. No matter our opinions and thoughts, greater understanding and close relationships are what define the human condition.
One of the primary teachings I learned while earning my journalism degree was one of neutrality and learned objective behavior. “A reader should never know what your opinion is. Save that for the editorial page,” a professor preached to our class. To counter the need to disagree, I was taught to ask why. There is always more value in understanding why someone believes something than trying to convince them why their thinking is flawed. To ask the question and learn about their thought process (if there is one) can lead to greater understanding for the person asking the question and sometimes illicit the process of critical thinking in the one whose opinion differs from your own.
At the end of the day, this life is about relationships. Humans connecting with one another. Maybe we can be an example for the pundits and the politicians who want to gain power by dividing rather than unifying. One can only hope.
10 Ways To Screw Up Your Kids Without Even Trying
During my years in the practice of psychiatry, I frequently heard parents of children who were in trouble lament: “Where did I go wrong? I did my best to be a good parent.” Some might even point out they had read Dr. Spock cover to cover more than once and Dr. Brazelton’s Touchpoints books. I always tried to reassure them that they were not the only people influential in their kid’s lives and that we parents are probably not as powerful as we think we are. Most people would agree that children are quite capable of screwing up their lives without help; however, I think there are some ways in which parents can contribute to the process.
1) Protect and serve
I recently had a conversation with a retired school teacher who mentioned her difficulty dealing with the so-called helicopter parents who fly in at the first sign that anyone dare suggest their little cherub could do something wrong, or be imperfect in any way. A note to the parent suggesting something less than perfection in behavior or scholastic achievement is likely to result in a visit from the enraged parent to defend her poor little helpless child. The parent’s explanation is to blame someone else, usually the teacher, for the problem.
My teacher friend seemed have less than a high regard for helicopter parents (but to be precise, “helicopter mothers”). However, my teacher friend apparently had not considered that this behavior could be of immense value to the child in learning to cope with the exigencies of life. She did not take into account that the assumption of responsibility is not a highly valued quality in modern society, and that for little Johnny to learn to blame others for his problems could smooth the way for him to grow up to be very successful should he choose the right vocation. A career in politics comes to mind.
Additonally, the helicopter parent may also benefit from the practice of always defending little Johnny for these skills might be valuable later in juvenile court.
2) Don’t snoop
Most kids seem to feel they have a constitutional right to privacy. In my personal experience, nothing a parent can do is apt to generate more ire in kids than the violation of this precept, and to snoop places a parent at great risk. Besides, the discovery of a stash of condoms, or weed could lead to a lot of trouble. From the little I know about the electronic stuff, it seems virtually impossible to snoop. Therefore, a parent might as well hope for the best about what is going on in their child’s life. Your child is apt to guard the password to his/her computer with their life, and you certainly would not want to suggest he/she is untrustworthy.
It is mandatory that your child has a TV and/or computer in his room where he can escape from the family and watch skin flicks without interruption. It is important to remember like what the airplane has done for transportation, TV porn has done for sex education with the added advantage that there is no need to have that embarrassing conversation about the birds and the bees. In short you can avoid a lot of controversy by treating the door to Johnny’s room as if it were the entrance to a bank vault.
3) Don’t listen
Some so-called experts advise that children should be allowed to express themselves. I grew up hearing that “children should be seen not heard” which seemed to work out alright for me, as I grew to be as opinionated as the next guy. I suggest that kids are already mouthy enough, so it makes sense to tell them to shut up and do as they are told.
4) Encourage in-home activities
Much has been made about the detrimental effects to children of video games and cell phones. In my opinion these instruments have become the greatest boon to motherhood since Similac. No longer does Mom need to worry about little Johnny or Mary being accosted by some predator. She no longer needs to deal with muddy and grass stained clothes nor scrapes, bruises, or even an occasional broken bone. She always knows where to find them for they are either in front of the TV or on their cell phone.
Some people insist that these gadgets lead to a sedentary lifestyle resulting in problems such as obesity, poor muscle tone and a variety of medical problems such as type 2 diabetes and delayed reasoning skills, but they must not have noticed the dexterity of kids’ thumbs in action when they are texting. One can safely assume that as our digital age progresses, such a skill could be more valuable to your child than a burgeoning muscle mass.
5) Overindulge whenever possible
In this age of materialism, the most effective way to show our children we love them is to shower them with gifts.
If you celebrate Christmas you should consider that the kids are unlikely to remember any of that religious stuff, but they will never forget Santa Claus. Possessions are also an important measure of one’s status in society, and this principle applies not only to the kids but to the entire family. Our society has made giant strides in this area since I was a kid. When I was in high school there was only one student with a car and his dad owned a car lot. Now when I pass the high school parking lot it is jammed with cars with an overflow across the street in the church parking lot. It is true that some are not late models, but even those less wealthy kids need not suffer the humiliation of being seen boarding a school bus.
I am well aware that this may put a strain on the family budget; however one should bear in mind that credit card companies are usually very accommodating when it comes to increasing your credit limit. If all else fails Dad can always get a second job or a third one if he already has two.
6) Keep them guessing
There has been much made by so called authorities on child rearing about the importance of consistency, but I feel consistency is overrated. B. F. Skinner’s experiments have clearly demonstrated that intermittent positive reinforcement is the most effective tool to shape behaviors; consequently, house rules should never be rigidly fixed, but fluid and subject to change at the whim of those in charge. To be confident of the reaction to his actions is apt to render him a lazy thinker, while confusion as to an outcome will require deductive reasoning. Some kids are likely to initiate certain behaviors in order to see what reaction it will generate.
It is also helpful if the parents disagree on many issues. This can result in valuable training in how to manipulate people, e.g., play one against the other. In the matter of discipline most of us can remember the old “wait until your dad gets home threat.” In the event that Mom remembered to tell him his response would largely depend on his mood or if he had stopped for a couple of beers on the way home. It could result in anything from “a good talking to” to a trip to the woodshed. In the latter case with today’s attitudes towards corporal punishment confiscation of the perpetrator’s cell phone would be necessary to prevent him/her from calling Children’ s Service.
7) Shame them whenever possible
I once wore a dunce cap. Few who read this will be old enough to remember the power of the dunce cap. It was usually cone shaped and made of paper, and its adornment was accompanied by a sentence of standing in the corner for a lengthy period of time. Its presence announced to the world that one had done something terrible. In my case, I had the audacity to talk in class. It was a two-room school and I was in the second grade. I was spared the paddle, which was displayed prominently behind the teacher’s desk, but was assured that it would find my backside were my behavior not to change. To make matters worse, the teacher was my uncle which guaranteed that my parents would learn all about my transgression.
The humiliation was made complete by the teasing I suffered at the hands of the other kids not to mention the “dressing down” (The time out strategy had yet to be invented) by my parents. The whole experience was remarkably effective as I never talked in class again. From that incident and others I suggest you not hesitate to use ridicule, and shame to shape your child’s behavior.
8) Teach humility
Children are born with an exaggerated sense of their own importance. Babies seem to know that if they cry people will hop to and immediately make them happy. In many cases this persists through the teen years, and has been accentuated by the propaganda of Mr. Roberts who was able to convince legions of rug rats that they were special. The process of comparing your child to those with superior talent or success will go a long way towards bringing him down to earth. It will also provide him with goals, but at the same time help him face his limitations so as not to waste energy or time on trying to become something he is not. Children need to face reality; consequently, if they are stupid, ugly, awkward, or weird they need to know about it. Yes, I am aware of all that psycho- babble about self-esteem, but if the kid is a slob like his old man, he needs to be told about it.
9) Don’t have dinner together
This is a subject dear to my heart for mealtime is my favorite time of the day, but come to think of it all the time is mealtime for me. However; I don’t feel that I am unique in that regard for modern families have given up the ritual of all sitting down together at an appointed time to break bread. That is probably just as well as a lot of time is wasted on such things as reviewing each person’s day, and making small talk. It was often the only time of the day when the entire family would spend time together. There were also the obligatory lessons in table manners, nutrition and hand washing. At times minor squabbles would energize the experience, but all in all it was not very exciting.
Modern families (not the one on TV) have no time for such foolishness. There are too many activities and conflicting schedules to even consider such an old fashioned habit. Mom may have trouble making it home from work in time for dinner let alone prepare a full course meal. Often ordering a pizza or stopping by for a sack of Big Macs makes a lot of sense, but responsible parents will all be sure to keep a jar of peanut butter as backup. Crock pots have been a boon to today’s families as food can be made available at anytime and the ordeal of eating together can be avoided. The old policy of sit down family dinners pales when compared to the convenience of an every man for himself system.
10) The responsibility myth
One of the most difficult problems for families is deciding who should be responsible for taking out the trash. If the kids are assigned to take turns, there will be endless loud and disturbing bickering about who did it last. The timeworn strategy of listing a schedule on the refrigerator rarely works as it is subject to editing and will often disappear before it is implemented. When responsibility is fixed, you will witness such creative thinking in the formulation of reasons why the chore was not done that you can be very proud.
Eventually, you will come to realize that the energy required to fix responsibility, not to mention the frustration involved will lead you to conclude that the best solution is for you to take it out yourself.
I am reminded of an incident in my own family from many years ago involving my son. Barb had become very frustrated with him. She complained that his room was a mess. When she ordered him to pick up the clutter on his floor he simply shoved it all under the bed. She was incensed and insisted that I “do something.” When I asked what I should do, she replied: “Go up there and stay with him and make him be responsible.” My brilliant retort was: “If I do that, then who is responsible?” I did come up with an equally brilliant solution however. I simply walked upstairs and closed the door to his room.
You cannot force your child to be responsible so let him/her go. As an adult they will learn all about the wages of irresponsibility soon enough, besides you don’t need the hassle. It’s just a lot of work.
Conclusion
Some of you may not wish to screw up your children’s lives, but before you come to that conclusion you might want to consider all the ways they have screwed up yours. Think of all the sleepless nights, the school PTA/PTO meetings, volunteering, chauffeuring, the crying, whining, and the dirty diapers not to mention the enormous sums of money spent on them. You will need to decide if it is worth it. In spite of my best efforts to screw up my kids’ lives, they l have all turned out well. Go figure.
DISLAIMER: I strongly deny receipt of any remuneration from the American Psychiatric Association in return for the recruiting of patients.
FAMILIES
FAMILIES
In previous blogs I have discussed the importance of relationships in our lives; however none are more important than our relationships with our family of origin. They will be a powerful influence as to how we view the world and other people. More importantly, these experiences will be major determinants in the development of our personalities. Those fortunate enough to grow up in nurturing environments will find it easier to nurture their offspring. To feel loved is likely to protect one’s self-esteem, and allow one to experience the joy of loving others. Our values are in many ways shaped by family for even if one is rebellious and rejects what he has been taught, his new found truths often originate from the nature of his family relationships.
Apprenticeship to Adulthood
We humans are unique among mammals in the length of time required for us to reach maturity. Not only is our rate of growth slow, but there is much to learn if we are to survive and thrive in a complex society. Although much is determined by our genetic make-up, we learn behaviors and perceptions primarily by unconsciously mimicking others. In that sense, growing up is much like an apprenticeship.
The 21st Century Family
An accurate definition of family is now difficult to pin down. There are no longer traditional roles for family members, such as were the norm in my generation. Since most parents work, there are fewer stay-at-home moms. We now see an occasional stay-at-home dad, something unheard of in my time. Other than widows, single mothers were not nearly as prevalent during my youth as they now are. Modern mobility has limited the number of nuclear families who can experience the support of extended family members. Many of our children grow up barely even knowing the names of their cousins. Blended families composed of his, hers and their children can face special challenges.
The Power of the Family Bond
In spite of these changes, the bonds between family members are among the strongest of all our relationships. This is evidenced by the fact that one of the first phases of recruitment by cultists is to alienate the prospect from family members, usually leaving siblings and parents confused and devastated. The same tactics are used by those who would attempt to relieve the elderly and infirm of their possessions. In both cases, they discredit the families of origin and attempt to break the bonds between the victim and the victim’s biological family. Those in positions of leadership of all stripes realize the strength of familial relationships, and seek to provide an atmosphere in which a surrogate family can develop. Street gangs likewise are said to provide family like bonds, which have been lacking in the lives of those they recruit. The search for the type of relationships found in families seems to be a common human need.
“I found it difficult to remain therapeutic while feeling homicidal.”
Although families offer the best environment for rearing children, they can also be the scene of horribly abusive behaviors. I have had little experience dealing with such problems, especially when they involve children. I generally avoided treating such cases as I found it difficult to remain therapeutic while feeling homicidal. In like manner I find that the understanding of other cultural practices such as honor killings, genital mutilation and such to be way above my pay grade, and in spite of being paid quite well. Consequently, I will confine my remarks to treatment of more mundane problems.
Who is the “real” patient?
Most families seeking help are usually concerned about the behavior or mental status of one of their members. They are often coerced into treatment by the identified patient’s therapist. That term (identified patient) is useful in that one may find that the person in treatment may be the healthiest member of the family, and labeled as sick because he is out of step with the rest of the family (i.e., the identified patient is actually the most emotionally healthy of the group who is reacting to an unhealthy family dynamic).
The importance of family therapy
There are multiple reasons that I believe involvement of family is critical in the treatment process:
- Family members may be able to provide valuable information about the patient’s behaviors.
- It allows the therapist to view family relationships first hand and thus provide insights as to the stresses in the patient’s environment.
- Family members may provide a more complete family history
- It allows the therapist to assess the level of support available, and to encourage such support
- Perhaps most importantly, it is a mechanism in which the dilemma of providing family with needed information about their loved one’s illness without violating the confidentiality inherent in the doctor-patient relationship. This becomes even more important in those cases where there are paranoid tendencies, or there has been a great deal of conflict.
The Complexity of Family Relationships
Although the average family size has shrunk considerably over the last century, relationships between members can still be complex. It must come as no surprise that there are often conflicts within families. Since it is difficult to walk away from one’s family, those conflicts are not easily resolved, and over time may escalate. To be chronically angry can be debilitating and painful, and as such, blaming another for those feelings comes easily.
The Blame Game
As mentioned in previous blogs it is important that the therapist avoid joining in the search to establish who is at fault, for to do so merely perpetuates the problem. He must be able to analyze the problem from the outside looking in, that is, learn how to be a meta-communicator. Hopefully, the members will find it difficult to continue blaming each other if the therapist redefines the problem as blaming rather than defining the problem as identification of who is at fault.
The Power of Brevity
In order for the therapist’s comments to be effective, they must be brief if they are to be remembered. The importance of brevity as with most things in my practice was learned from a former patient during a chance encounter, during which he thanked me for having helped him several years previously. He credited his recovery to one statement of mine. He said: “The thing that helped me most was when you said ‘you think too much’ and now whenever I start to worry about all the things which could go wrong those four words come into my head and I am able to move on.” I cannot take credit for any brilliant insights for I didn’t even remember the incident, but it is an example of how an offhand comment may be more effective than hours of therapy. The same principle applies to our everyday lives, as the most memorable comments are those expressed in a few words. The lengthy ones are often forgotten before they are completed.
Obviously there are many reasons for families to seek counseling other than to deal with hostility, but no matter the problem it is helpful to look at it as a communication system gone awry. Imbedded in many different behaviors is a message, and thus can be seen as a form of communication. For example, what is the message being sent by a teenager who is acting out? It could be that they are angry about limits set, unrealistic expectations from parents, lack of trust by parents, sibling rivalry, or resentful that not enough limits have been set, or for reasons which have nothing to do with the family. Of course, the teenager is almost certain to be the last person likely to divulge such information. Disclosure can many times offer a pathway to an understanding, which may be therapeutic.
Can’t see the forest for the trees
It was not my intent for this paper to be a treatise on family therapy; however I thought it might be useful to see how some of the concepts could be useful in understanding not only our own families, but relationships in general. As I mentioned in a past blog as with marital relationships, it is almost inevitable that one will be so caught up in seeing the trees that he will become oblivious to the forest. That is, he will not realize what is going on even though he can hear the words. This was brought home to me several years ago when following a party a colleague said “Smith I can’t believe how you treat your wife.” I was shocked, could he be talking to me, the couples therapy and family expert? After all, I had no doubt that I was among the world’s best husbands, but Barb later confirmed that my friend was correct in his assessment. As has been said, “None are so blind a those who will not see.”
Reframing
For example though all have separate personalities, they also have different roles to play as family members. For example it is common for families to have a star and a black sheep. Parents may lament that they don’t understand why the black sheep can’t be more like the star, and continue listing all of black sheep’s misdeeds and faults. In such a case the therapist might address the black sheep kid by saying, “That is such a loving thing, doing all that stuff to make your sibling look good.” No matter the response the system is changed, and this is apt to open up some different dialogue. This is a process therapists call “reframing.”
Scripting
There are many roles that kids and parents may unconsciously adopt. There are the placaters or people pleasers, the mascot or clown, the lost child or withdrawn person, and as mentioned in the previous vignette the hero or achiever, and the black sheep or scapegoat, to mention a few. Family roles may develop in order to fill a need or may come about by the process of scripting. I mentioned previously the role families play in the development of our identity, and when they convince us we are a certain type of person, we are apt to follow that script. Some have gone so far as to say if you can convince someone he is a homicidal rapist, he is apt to become a homicidal rapist. Obviously, there are many influences other than our families which affect our identity; however, the opinions of our parents and siblings are undoubtedly the most powerful.
Disagreements
In this time of rapidly changing mores, it is not surprising that there will be frequent disagreements between we old folks and the kids. Of course disagreements between siblings seem to be written into their DNA, and disagreements between parents is certainly not unusual. When family members cannot agree to disagree, an argument is likely to occur, and such arguments often lead to verbal or even physical attacks. I don’t mean to suggest that disagreements are all bad for as Walter Lippmann famously said, “Where all think alike, no one thinks very much”. When we tell our kids what to think while telling them we want them to learn to think for themselves it is little wonder they become frustrated for that is a classic double bind, or in today’s vernacular a no win situation.
Systems of Conflict Resolution
If a disagreement reaches the point that one feels threatened or under attack, either verbally or physically, he may respond in a variety of ways.
Attack/Attack system
He may retaliate in kind which is an attack-attack system. This is almost guaranteed to increase the level of anger, as each participant attempts to outdo the other. These are the types of interaction which can lead to violence.
Attack/Placate system
The attack-placate system is often seen in cases of spouse abuse, when the abused attempts to talk hubby out of his anger by reassuring him and in other ways spreading oil over the troubled waters. This too usually fails as the abuser may feel patronized.
Attack/Divert System
Another type is the attack-divert system which as you might imagine can become rather bizarre. This might be effective in minor skirmishes, but simply changing the subject in the face of overt hostility is weird, and leaves the problem unresolved.
Acknowledge the Affect
For the best method to deal with such emotionally laden situations, I hearken back to my mantra of “acknowledge the affect.” In such cases, the message the attacker is trying to send is that he is feeling some kind of negative affect such as: anger, hurt, envy, jealousy, or fear. Statements such as “I can see you really feel strongly about that” or “are you angry with me?” will often defuse the situation. It is not necessary to change your opinion or point of view, but simply to communicate that you understand how he feels. If your attacker’s affect is not available then one can use his own such as: “I feel …………” The concept has wider application, for in any emotionally charged situation it only makes sense to deal with the emotions rather than to ignore them.
What’s Next?
In my next blog, I plan to focus on child rearing. I am well aware there are probably hundreds of books written by people who are convinced they know better than you how you should raise your kids. I don’t plan to do that since I have made plenty of mistakes in that department; although my kids all turned out well in spite of my screw-ups. Rather than directions as to how one can raise perfect little people, I plan to provide helpful hints on how to screw up your kids lives: I call it “How to screw up your kids without even trying.”
Thanks for reading!
DO YOU HEAR ME NOW
Editor’s Note: Image not approved by e-shrink, but I needed some eye candy 🙂
In a previous blog, I promised an encore presentation on the subject of interpersonal communication. Your patience is about to be rewarded for I will now set about to fill these pages with the words of wisdom promised.
Actually if one excludes extrasensory communication and similar spiritual phenomena, there is little mystery about how we communicate with each other, but it is amazing how we can screw it up. It appears that all creatures have some means to communicate. Some plants are said to communicate with each other, and I just read an article in Scientific American presenting evidence that some bacteria send signals to others of like kind.
The Dawn of Communication
It is impossible to know exactly how earliest man communicated, but it can be assumed that job one as they came together as groups and then tribes, was to be able to communicate with each other. They would soon find that gestures and other nonverbal means were not sufficient for them to be successful carrying out joint efforts, like gathering food, providing shelter, and protection. Sound would prove to be the most effective means. Messages could be carried over distances without interrupting the sender’s activities. For example a certain sound may have been agreed upon to sound a warning. Meanwhile, man would be evolving physically with very versatile machinery to produce a variety of complex sounds which we now call words and language was born.
Necessity is the mother of invention
Since our Great, Great, Great, Great………..and so on grandparents, like us, were never satisfied with the latest technology, they would undoubtedly start looking for ways to communicate distances beyond their range of hearing. It would also be nice to save and share messages. Smoke signals and other such signaling procedures would have little useful utility. They solved that problem by devising symbols for each word thus enabling them to not only hear, but also see all those words. Fast forward a few thousand years, and here I sit recording words in this mysterious black box. As you are all aware this is not the end of that story, but more about that later.
Most of us talk better than we listen
Of course humans have developed the most complex system of communication centered on our verbal language skills. As a matter fact, many anthropologists rate our ability to use language as the major factor which allowed man to become the dominant creature on the planet. It is language that allows me to write this paper, and to communicate ideas, opinions, directions, knowledge, feelings, or indeed any thoughts which come into my head to anyone who is inclined to listen, and therein lies the most common flaw in any communications system, i.e., most of us talk better than we listen.
Psychiatrists listen, it is what we do, as a matter of fact sometimes that is all we do. It has always amazed me how therapeutic listening can be. There are many times when patients have left my office saying they felt much better after venting their particular problem, in spite of sparse verbal responsiveness on my part. It makes me sad to think that some people find it necessary to spend money to have someone listen to them. Come to think of it, if we all would be better listeners it might save a lot on shrink bills.
I can identify with those people who feel no one listens for I have always envied those guys with deep commanding voices who are able to dominate a discussion. In those situations I am rather soft spoken and sometimes feel excluded. My attempts to change the timbre of my voice have been unsuccessful; consequently; I am usually content to let my wife take the lead in those social situations as she is very good at social repartee.
The Nuts and Bolts of Communication
Everyone knows that in order to have a communication, one must have a transmitter and a receiver. For the sake of brevity (my readers seem to appreciate that quality in these blogs), I will limit my comments to communications between people; although, I realize there are now many machines that communicate, and that animals communicate with each other and with us. It is important to remember that in the presence of other people it is impossible not to communicate, for paradoxically not to communicate sends a message: therefore a communication has taken place. When one ignores another person, it may send a powerful message, but one which can be interpreted in many ways. The message may be clear depending on the situation or context, but can also be confusing.
An outstretched middle finger pointing skyward will rarely be misinterpreted
Verbal conversations are the most versatile and intimate of our means of messaging while written messages are less likely to be misunderstood. Non-verbal messages can also be very precise, for example in our society the presentation of an outstretched middle finger pointing skyward from an otherwise closed fist will rarely be misinterpreted. In spite of such exceptions, words are generally the more precise tool. The superior quality of verbal versus non-verbal communication is evidenced by the difficulty those born without hearing experience as compared to those who are blind. It is well known that a person’s lack of one special sense will result in a compensatory increase in acuity of its opposite. The result for deaf people is that they can become markedly adept at sign language, but to converse with hearing people becomes very difficult. They must either use crude gestures, or depend on written messaging, the first being ineffective and the second inefficient. Lip reading is apt to be fraught with errors and may not even be possible for those born deaf. Blind people however converse with little difficulty and their enhanced hearing may allow them to hear inflections which might go unnoticed by those with normal vision which could help make them superior communicators. The result is that deaf folks often prefer to relate to others who are deaf, while blind people find it easier to assimilate into ordinary society.
The Art and Science of Listening
As I mentioned previously, I believe that failure to hear is usually due to a failure to listen. Listening requires effort. In order to be an effective listener one needs to use all of his faculties, including not only his ears, but also eyes, touch, and sometimes even his sense of smell. It goes without saying that it is essential to be attentive, and to maintain eye contact unless the one talking seems uncomfortable. Observing a person’s posture and movements are all part of the listening process. For example, folding one’s arms across their chest indicates they are not likely to be receptive to your comments. Of course there are many less obvious non-verbal cues which are delivered unconsciously, to which we may respond to without awareness they have occurred.
People who study non-verbal communications can gather amazing amounts of information by simply watching a person. While teaching both individual, couples, and family therapies, we often would show a video tape of a session without sound, and speculate as to what the body language revealed. If the therapist who conducted the session was present he/she would usually be surprised at his/her lack of awareness of some their own non-verbal behaviors. Although a thorough review of the subject is way beyond the scope of this paper, we can learn some things which can be helpful to enhance our abilities to really listen just by watching.
Listen with your eyes
Most cues will be obvious, the breaking of eye contact, leaning forward or backward in a chair etc. One very telling clue as to our engagement is the shifting toward or away from symmetrical positioning e.g. the mirroring of postures. If the person with whom we are conversing mimics our sitting position, it is likely that they are engaged in the conversation, and to change positions will indicate disengagement. We are likely to sense those changes in others more easily than in ourselves. Leaning forward toward the conversant will indicate interest and encourage more talk on the subject while leaning back can be interpreted as: “enough of that subject.” At the same time it may be helpful to remember that if you are bored you probably will look bored, and you will give off the same signals as your bored companion. As mentioned previously, words are still your best shot to receive a clear message, and the non-verbal stuff should be viewed as ancillary.
The Transmission
Now that you know everything there is to know about being a receiver, we can move onto how you may become a talented transmitter. If you are to become a scintillating conversationalist, or a raconteur par excellence you must learn how to deliver a clear and succinct message. This must not be as easy as it sounds for even when listening as hard as I can, I sometimes have no idea what is being said. The KISS acronym (keep it simple, stupid) is still a good rule when it comes to personal conversation. Complexity tends to obscure rather than illuminate. Most contemporary poetry violates this rule in my opinion. My attempts to understand it leaves me with the same feeling I get after spending a half hour working on a rubric’s cube. I confess that I carry a few big words around to use when I want to impress; however long multisyllabic words should be avoided if a little one will do. (You may notice that I have used some of my favorite fancy words in this paragraph, and I trust you are duly impressed).
Direct vs Indirect
Conventional wisdom is that one should always be direct with one’s communications, and “not beat around the bush” as my grandmother would say. In general that is a good rule to follow; however there are times when one might need to deviate from that practice. It brings to mind the solution that my wife Barb found to a vexing problem. It involved a young man who did some office work for her from time to time. The problem was that he had a persistent very strong body odor. She was concerned for him, and suspected the B.O. might well have something to do with his limited social life. Of course, she was reluctant to confront him directly. Although her maternal instincts had kicked in, she did not feel close enough to him to be comfortable discussing his problem directly. After considerable deliberation she resolved her dilemma by giving him a box of deodorant soap for Christmas. Unfortunately, she had no follow up with which to judge the success of her coded message.
There are times however when a direct communication is the best choice in embarrassing situations. One personal example happened while I was giving a lecture to a group of nurses. I noted some snickering among them which was puzzling since grief was the subject of the talk. I later learned that my fly was unzipped. It would have been an act of kindness to have been informed of my zipper problem. To make matters worse, I was forced to endure taunts by colleagues that this was an obvious Freudian slip.
Sending manure and roses in the same box
Although words are of the utmost importance in communicating, we must not forget the music that goes with them. By that I mean the tone, volume, cadence, pitch, and other elements produced by the noise maker in our windpipes. The mechanisms we use to produce sound is remarkable in its versatility and is capable of expressing innumerable emotions which can accompany our words. What we say can be modified, enhanced, diminished or even totally changed in their meaning by our voices. When the words fit the music it can add clarity, but when they don’t it can be confusing. This also applies to visual clues as previously discussed. In those situations in which sound contradicts the words, we have two conflicting messages in one. The purpose of double messages is usually to express hostility, but make it difficult for the recipient to respond as we used to say at the lab: “to send manure and roses in the same box”. In such cases it may be difficult for one to decide which is the more pungent odor.
Sarcasm and the double message
Sarcasm is probably the most recognized form of the double message; however there are some who are masters of the technique. Some women are said to be “catty” in their conversations with other women For example at a dressy social function Miss Catty might say, “What a nice dress, I saw one just like it on the dollar rack at K-mart the other day.”The recipient of this message is apt to remain speechless unless she is quick enough to come up with an equally sarcastic response. In any event the two are unlikely to become friends. There are words and phrases which can be interpreted differently. Some idioms can be confusing and even suggest opposite viewpoints. Since language is never static some may change in their meanings as for example the phrase, “cute as a bug” usually referring to a younger person now seems to be accepted as complimentary; however I don’t believe many people would consider bugs cute.
Anger vs Hostility
Many people find it difficult to deal with anger either of their own or others. This can be limiting in their ability to form lasting and honest relationships for there will always be reasons for anger towards others whether real or imagined. Unexpressed anger will result in either hostile behavior or depression.
In our so called civil society it is often deemed inappropriate to express anger directly, but rest assured it will be communicated by all those non-verbal means we have talked about in spite of our best efforts to conceal it. Contrary to public opinion anger and hostility are not synonymous. Anger is an emotion while hostility is a behavior. Hostility is unlikely to resolve the issues which perpetrated the anger, and furthermore the response to hostility is apt to increase one’s anger.
The efficient and healthy way to express anger
There is a very simple and efficient way to express anger and that is to say “I am angry with you.” This will allow the source of your anger the opportunity to ask about your anger and consider options other than fighting. As I mentioned before, you are the only expert on your emotions so they can’t be refuted by others. If he shows no interest in resolving your differences, you are best off to just dump the sucker.
When you’re on the receiving end of anger
The opposite side of the coin is when you are the recipient of the anger or hostility. If the person is sufficiently enlightened to open the conversation with their feelings of anger, you have a good chance of resolving the issue, but it is more likely that it will be hostility, e.g., name calling, accusations, jealousy, or even physical assault. In the latter case just run unless you have a ball bat handy.
Acknowledge the affect
In other circumstances you may be able to diffuse the hostility by acknowledging the affect. The affect for you non-shrinks is the word we use for feelings. As a matter of fact that phrase: “acknowledge the affect” became my mantra when teaching psychotherapy. Phrases such as, “you must be very angry, or you really look mad,” may lead to a more productive discussion. In some cases it may be more effective to use your own affect especially if there is no response to your acknowledgement of his anger. Whatever you say must be honest, like “I feel sad, this hurts my feelings, or you are scaring me.” Although these strategies do not guarantee success, they are less likely to result in escalation of the conflict. Of course sometimes we would rather fight and in such cases that remains a prerogative; although it is often difficult to determine the winner.
Being assertive without hostility
Many of us have grown up in homes where we were taught to be submissive. This is probably true for women more often than for men. Then we grow up and find that we must be assertive or be ignored. Our childhood experiences of assertiveness was usually linked with anger, but as we grow up we learn that to be accepted into society we must learn civility. The result is that in this competitive world we must assert ourselves or be left in the dust. The problem is that we don’t know how to be assertive without being hostile. This was a problem for many, many of my patients. As women strived for more independence, and learned to work alongside men who were accustomed to being considered the dominant gender their need for assertiveness training increased, and this need is not confined to women. Learning to recognize feelings will help one to compartmentalize them and learn how to communicate without unwanted hostility. In other words acknowledge the affect.
The Awesome Complexity of Communication
The subject of interpersonal communications is obviously much more complicated than what is presented here. It is estimated that our vocabulary includes between 10,000 and 17,000 words depending on age and education level. When the myriad non-verbal modifiers are added coupled with the thousands of ways words can be arranged we become aware of the awesome complexity of this function which we take for granted.
P.S. I am a bit anxious about submitting this for publication as I have a grandson who is about to graduate with a major in communications. I can only hope he will be merciful in his critique.
Next time, I hope to share some thoughts about families.
THE SMARTEST GUY “He’s so smart, I didn’t understand a word he said.”
Editor’s Note: Due to my ability to type really fast, one of my first jobs was to use the Dictaphone at my dad’s office to type information dictated by the psychiatrists. I would use my foot to press the peddle that played the tape and type along as they spoke. I typed letters to consulting physicians and articles they wrote for publications. I remember being surprised at my dad’s vast vocabulary. He certainly didn’t use those fancy words in the office or at home. When I discussed this perplexing issue with my dad, I learned two lessons that have stuck with me my entire life. 1) Don’t use a dollar word when a dime one will do. 2) Know your audience and communicate in the language they speak. One of our running family quotes is part of this blog post: “Doc, he was so smart I didn’t understand a word he said.”
THE SMARTEST GUY
My Grandson gave me an interesting book for Christmas. This is not a book review so the title is not important. Suffice it to say, it has to do with some theological issues which he and I had discussed in the past, and in particular a “doubting Thomas” streak owned by me. There was much food for thought, some of which was not very digestible.
The author was obviously well read as there were 53 pages of references cited. It was well written; although I found some of the reasoning a bit convoluted. It was a tedious read for me, but I must confess that I also have trouble deciphering the Bible. All of the quotes the author offered throughout the book often added to my confusion. I am sure those guys are all very famous; however I had never heard of most of them. The author would make his point then throw in a “in the words of……….” which was not nearly as coherent as his original statement. Perhaps he was only paying homage to the experts in his field, but I was impressed that he must be a speed reader to have read all that stuff. I was also surprised to learn that Christianity could be so complicated.
As I read the book, I was reminded of an experience from many years ago. I was seeing a patient for the first time. His was a chronic, although not disabling condition, which had been exacerbated by the unexpected death of his psychiatrist. He talked warmly of his feelings for the deceased, and shared that he missed his counsel. He also spoke of his respect for the man’s intelligence with: “Dr………. was the smartest man I ever knew. He was so smart that when he said something I couldn’t understand a word he said.”
Now all these years later, I can identify with this patient’s assessment of the good doctor’s intelligence for some of the guys quoted in the aforementioned book were much too smart for me to understand. You may be thinking that the alternate explanation might be that I am too stupid to understand, a conclusion that I am loath to accept. After all, I did manage to limp through 24 years of school even though my scholastic career was admittedly undistinguished. My mother proudly said that I knew my ABCs, and could count to 100 by the time I entered the first grade. I have a vivid memory of my father showing my third grade report card to everyone in Varner’s store who would look. Even though this was the first and last time he would be able to exhibit a report card with all A’s, I feel it should count for something.
There is the possibility of another less flattering explanation, which could help explain the comprehension problem. I have a friend whom I have always admired for his scholarship. His writings demonstrate a vast knowledge of classical literature, history, philosophy and classical music. He is also a veritable expert in psychoanalytic theory. His writings make use of metaphor and relevant quotes. Imagine my surprise when in my confessions of envy for his use of all this knowledge in his writings, his wife responded, “I think it is just showing off.” Perhaps she was having a bad day or he had forgotten to take out the trash, for she has shown her love for him in many ways during the many years they have been together.
The comment by my friend’s spouse does raise the question as to whether our writings are often more about ourselves than the subject about which we are writing. Could it be that sometimes the message intended may be corrupted by our ego needs? How much of the motivation of this author’s writings were motivated by a need to “show off”? For that matter does that same dynamic have anything to do with my writing of this paper. I have often said in jest that I would like to be rich and famous. Since the former has escaped me, perhaps I am still holding out for the latter. But then I have also had fantasies of winning the $1.5 billion power ball thing; even though I have never bought a ticket.
When I was a kid we sometimes perpetrated cruel party jokes designed to humiliate and embarrass. One such stunt involved telling a joke with a nonsense punch line. The group who was in on the joke would laugh loudly, and the butt of the joke would join in the laughter even though there was nothing remotely funny. We called such tactics “shaggy dog stories.” I must admit there are times when I feel I have nodded in agreement with someone when I had no idea what they were talking about, much as the patient who idolized his dead psychiatrist must have done.
There are times when reading something that is clearly beyond my abilities to grasp, I wonder if I am the victim of a shaggy dog story, and that the author is having a good laugh at my expense. The most recent example is my attempt to wade through a book on quantum mechanics. I was humbled by my inability to make any sense of that stuff. Upon learning that the book was written for ordinary people like myself left my ego was left in shreds. This was not Greek to me. It was more like a mixture of Mandarin Chinese, Arabic and Apache indian. What I could decipher was so implausible that I found myself thinking “can this person be serious?” and again wondering if this was not a variation on the shaggy dog theme.
It has been said the best defense against Alzheimer’s and similar dementias is to make liberal use one’s brain. All intellectual pursuits are encouraged, but I have noted that this can clearly be overdone. I submit that a brain can also become fatigued; consequently, I will now put down my book on particle physics, fire up my kindle, and escape to a mindless mystery novel.
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