The Secret Role of Hope in Psychotherapy

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I am always amused when a TV pitchman offers to sell a secret “they won’t tell you about,” promising to make you a million dollars. Well, the “secret” I’m about to disclose is something rarely discussed, but not intentionally hidden: a form of hope. This type of optimism, however, is not what most imagine when they think of such words.

The standard well-acknowledged place of hope in therapy is for the therapist to communicate that the future can be better. His authority and experience are implied and therefore increase the chance of belief in him. They tell the patient, in effect, “I’ve seen others recover. People can overcome depression and anxiety. This is also possible for you.”

For some of his clients, however, his cradling of hope takes an additional form. Too many of us live in a psychological concrete canyon, like ones found in the narrow avenues bordered by tall buildings in major cities. We cannot witness what is behind these skyscrapers, nor a sunrise that is the gift of the horizon. Less metaphorically, we cannot recognize what role we might occupy in the world, beyond filling an unsatisfying, modest or disadvantaged place similar to those in our past. Dr. Seuss gave this encouragement:

You have brains in your head. You have feet in your shoes. You can steer yourself in any direction you choose. You’re on your own. And you know what you know. And YOU are the one who’ll decide where to go…

Oh the places you’ll go! There is fun to be done! There are points to be scored. There are games to be won. And the magical things you can do with that ball will make you the winning-est winner of all.”

This is not meant to be fanciful. As one of the founders of the Zeolite Scholarship Fund at an inner-city public high school in Chicago, my friends and I met too many youngsters who, by age 16, couldn’t imagine themselves achieving a life past what was available in a dead-end community. For some, a hopeful future died aborning. Imagination died, as well.

A therapist faces this, too, in the blinkered vision — the crumpled expectation — of the person sitting opposite him. His patient might not be able to conceive of a different, more adventurous life of high level skill, romantic abandon, achievement, and abundance. He is, in a sense, like a child who hears early she can be President of the United States, but discovers this has never happened — not yet anyway —  in the USA’s 240-year history and therefore crosses off the goal. Yes, some individuals periscope beyond the concrete canyon, their parents’ bleak lives, and their country’s prejudice without a counselor’s help. Yet others need their therapist’s belief to develop an x-ray vision piercing invisible barriers, the walls so taken-for-granted one might not even be aware of them.

Hope of this kind is not simply founded in the counselor’s confidence you can overcome symptoms. Rather, it is aspirational — the hope beyond hope to a world of possibility your peers laugh at if you are one of the 16-year-olds I mentioned.  For those who never beamed at a respected person’s consistent belief in them before, the words come as a revelation.

Therapy is an enterprise driven by heartbreak in the direction of hope. “I’ll try anything,” you say to yourself, “even this.” Usually, however, the wish is to remove the negatives, not obtain a sense of fulfillment in life. Make no mistake. The two may not be mutually exclusive. Envisioning a future worth living is more than encouragement to wellness, but a step toward it.

What Robert Kennedy said on several occasions applies no less to changing the world than changing ourselves:

Some men see things as they are and say why.

I dream things that never were and say why not.

 The top photo by Jessie Eastland is described as 72 Seconds Before Actual Sunrise, Southern California, USA. It comes from Wikimedia Commons.

Too Many Balls in the Air: The Frustrated and Frustrating Life of ADHD

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He was dynamic, outgoing, and enormously entertaining.

He was creative, full of ideas, and energetic.

And he was one of the most frustrating people you would ever care to be around.

About whom do I speak? A bright, charming man with Attention Deficit Hyperactivity Disorder.

ADHD is more complicated than you might think. Although there is much written about it, I want to cover a few of the things that can be missed about the condition. But first, let me explain the name and define it.

There are three types of ADHD (Attention Deficit Hyperactivity Disorder):

  • 1. ADHD, Predominantly Inattentive Type. This used to be called ADD, but technically speaking, sufficient inattentiveness is considered a category of ADHD, even though little hyperactivity may be present. These are the folks who seem to be listening, but are lost in space; easily taken away by a tune, a sound, or an idea; the people who miss the details and forget the assignments.
  • 2. ADHD, Predominantly Hyperactive-impulsive Type. This is what most people think of when they hear or read the four letter acronym ADHD. People with this diagnosis are characteristically talkative, active, intrusive; a bundle of unmanaged, impulsive activity.
  • 3. ADHD, Combined Type (meaning it includes the symptoms typical of the first two categories); too many balls in the air, for sure.

What about the man I mentioned at the top; a person who had the “combined type” of ADHD?

He had lots of energy and ideas, so people found him engaging. But it wasn’t a very productive sort of energy. He would begin things, but not complete them. He was disorganized — losing keys and papers, and forgetting appointments. He promised to do things, but couldn’t be relied upon to do them as quickly or as well as expected, if at all.

This man (let’s call him A.T.) went nowhere fast; very fast. A.T. looked liked the “Energizer Bunny,” but mostly traveled in circles.

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He tended to over commit himself, taking on more tasks than he could handle effectively, chronically underestimating what he could accomplish in the time available. A.T. was routinely late for appointments, and made decisions quickly, without fully considering the longer term consequences of his actions. Bored easily, distracted more easily, and prone to procrastination, he knew that he wasn’t what others hoped for and expected. Although he was full of promise, his reputation was that of someone who was a thoughtless, irresponsible underachiever — an individual who needed minding.

Employers were disappointed, co-workers were frustrated by A.T., and his spouse was driven just a little crazy, feeling that she couldn’t depend on her partner. She’d married someone who was exciting, only to find that the excitement he produced was more of the “Oh, no!” kind that made her sweat when she discovered he was late to pay a bill or pick up the kids. Not surprisingly, she started to see him as just another one of the kids, as their partnership turned into more of a “disapproving mother/resentful child” relationship than either of them wanted.

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Before I tell you about A.T.’s treatment, let me say a few things that might not automatically come to mind about the condition and its consequences:

1. Hyperactive/impulsive ADHD individuals can sometimes look like they are world beaters, but mostly beat themselves; indeed, they are often chronic underachievers. If you are planning on forming a working group or partnership with such a person, don’t be fooled by a positive first impression of excitement and energy. You will almost certainly be disappointed down the road.

2. ADHD, even today, is sometimes not detected in schools. There are several reasons:

  • The inattentive form of this condition may well produce school failure, but not misbehavior. Inattentive children are often quiet and relatively well-behaved, unlike their hyperactive-impulsive counterparts.
  • School personnel may incorrectly attribute ADHD-like behavior to laziness or oppositionality. Moreover, school systems, even when they do formal evaluations, are frequently reluctant to identify problems that require additional resources and personnel, which they are hard-pressed to provide given their limited funds.
  • An ADHD child who is bright can compensate (to some extent) for his attentional problems by relying on his excellent intellectual abilities, at least for a while. Eventually, however, many of these children (as they age and school begins to demand more of them) find out that advanced intelligence is no longer sufficient to permit success.
  • There is no single standard measure that reliably identifies ADHD. Evaluators commonly use some combination of paper and pencil tests, clinical judgment, and attentional measurements. Intelligence (IQ) and neuropsychological tests can easily miss some of the most clinically obvious cases of this condition.

3. The fact that ADHD children are able to become “hyperfocused” on things like computer games or other tasks that they find especially interesting, does not invalidate the diagnosis of ADHD. Indeed, this sort of selective attention is seen fairly often.

Some researchers believe that those games provide rewarding stimulation in the form of frequently changing images, sounds, and challenges; as well as the success of achieving points or increasing levels of success, thus “capturing” the attention and imagination of the ADHD youngster. By comparison, the real world school room seems boring. Recommendation? Limit your child’s screen time, even in front of regular TV shows.

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4. Although many people are hesitant to take medication, ADHD is a diagnostic category that is especially responsive to psychotropic medication. Hundreds of studies support the effectiveness of such treatment for about 85% of children with this condition according to Russell Barkley’s authoritative 2006 book Attention-Deficit Hyperactivity Disorder. In a 2007 paper by Elliot and Kelly — “ADHD medications: an overview” published in the journal Attention — the authors state that “No medicine available to psychiatrists produces a more rapid and dramatic effect more safely than the proper dose of a stimulant to a patient with ADHD.”

5. If medication does work, it will likely be needed on a continuing basis, not as a temporary fix. The irony is that stimulant medication, which will cause internal agitation in those who are not suffering from ADHD, actually permits the person with the condition to focus more and become less prone to the hyperactivity/impulsivity that had been a problem.

6. ADHD is correlated with a greater risk of developing a Conduct Disorder, typically characterized by antisocial misbehavior and defiance of authority. Not surprisingly, such individuals often abuse alcohol or drugs (not only as an act of rebellion, but also as a self-medication designed to calm their hyperactive state). Adolescents and adults who have ADHD are thought to make up at least 25% of the population of prisons according to Barkley.

In all these examples, the impulsive, ill-considered behavior that is typical of ADHD takes a fearful toll. Such individuals are easily bored, requiring intense and novel reinforcement (rewards) to motivate them, and are prone to “sensation-seeking” — looking for extreme excitement that their condition seems to make them crave. Indeed, one patient of mine reported driving at speeds approaching 100 MPH on city streets simply for the feeling it produced in him. Nor did he think he was at much risk (or putting others at much risk) in doing so, thus demonstrating the poor judgment characteristic of those with the hyperactive-impulsive form of ADHD, as well as their tendency to disregard rules and authority figures.

7. While many general medical practitioners (GPs) can prescribe medication for ADHD quite well, some are hesitant to do so, sometimes due to lack of training or inexperience with this particular diagnosis. Cautious GPs will prescribe psychotropic medication, but are prone to giving doses that are too small. It is generally best to see a psychiatrist in such cases; that is, someone who specializes in the prescription of medication for psychiatric disorders.

8. The frustration that ADHD produces in school children can make them give up (and eventually drop out), believing that nothing they can do will make any difference in their performance. Some of them will become avoidant of academic or other work tasks because they believe that they will fail, thus producing a self-fulfilling prophecy. Many will get angry at the teachers, bosses, and parents who so often are reminding them of their inadequacies. Thus, ADHD fuels other behaviors that make a good life difficult.

What happened to our friend A.T?

You’d think it was simply a matter of telling him of the benefits of medication, wouldn’t you?

Not so fast.

He was one of those folks who was uncomfortable with the “idea” of having to be reliant on medicine. He told me that he didn’t “believe” in medication, as if it was a matter of religious faith.

A.T. was also quite narcissistic; in denial concerning his own responsibility for the things that went wrong in his life. Similarly, he had no trouble blaming others including bosses and wives. Not to mention that he drank too much and didn’t acknowledge that it was a problem. Indeed, he had only come into treatment at his spouse’s insistence.

One of the challenges of psychotherapy is the fact that few people fit “pure” diagnostic types. Instead, one must be aware of all the complicating factors that can make effective therapy difficult. This man’s narcissism, denial, and alcohol abuse certainly created just such complications.

Had A.T. been more motivated and self-aware, less prone to denying the misery he was creating around him, a cognitive-behavioral (CBT) approach to his ADHD could well have helped, even if he chose not to take medication.

CBT programs include formal guidance in planning and organizational skills, assistance in problem solving and decision-making, help in reducing the number of distractions in the environment, practice in new thinking skills, training in ways to reduce procrastination, and advice to help you cope with failure. Homework is required between sessions.

The program described by Steven Safren and his associates in the work book Mastering Your Adult ADHD, developed by psychologists at Massachusetts General Hospital and Harvard University, was able to produce significant improvement in about 50% of those patients who continued to have clear problems even after being treated with medication.

So, if you have ADHD, medication and CBT provide reasons for optimism that things can get better.

Just don’t drop the ball!

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The top image is the Carbon Cycle created by the U.S. Government Department of the Interior. The one that follows is the Tux Crystal Linus Award by Nevit Dilmen. The next photo was created by Thomas Pusch and is called Scolded By Mama. The fourth picture is of Two Men Playing a Computer Game by Love Krittaya. Finally, a picture of a Geode  by Whitsoft Development. All are sourced from Wikimedia Commons.

Father’s Day (via Dr. Gerald Stein – Blogging About Psychotherapy from Chicago)

This is a revised and expanded version of a post I wrote two years ago about my father.

Father's Day Father’s Day can be complicated. Like any day of honor, some tributes are deserved more than others, or not at all. Some obligations are carried out with joy, while others are a matter of dutiful routine. And sometimes there is pain, where once there was (or should have been) pleasure. But, for myself, Father’s Day is pretty simple. While I miss my dad (who died 11 years ago), the sense of loss is no longer great. He was 88 when he stroked-out in … Read More

via Dr. Gerald Stein – Blogging About Psychotherapy from Chicago

Growing Apart in Marriage

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In the black and white world of “absolutes,” life decisions are easy and obvious. But life as it is actually lived becomes a good deal more complex and muddy.

Here is an example:

Take a middle-aged man and wife, both approaching 50. They married young for many of the same reasons that other people do: physical attraction, the fun and good times of first love, and religious faith.

He had been groomed to work hard, build businesses, and accumulate wealth. She had been raised to refinement, home making, and the raising of children. Although both were college graduates, neither saw education at the time as more than the expected and required thing to do.

They both succeeded at their appointed tasks. He was often absent, working late to achieve and maintain the commercial success that he won. She had the major responsibility for raising the children and keeping the home a beautiful and congenial place in which to live.

Time passed. As the children left the home, she turned increasingly to her religious community for companionship and to the comfort provided by her faith, the one which he professed only nominally. She attended less to her physical well-being and gained weight. She was satisfied with her life, fulfilled and sustained by her belief in God and a like-minded group of co-religionists. This woman believed her relationship to her husband was satisfactory in terms that were typical of a long-married couple with grown children.

The man, on the other hand, became more interested in philanthropy and involved himself in charitable projects in which the wife was uninterested, simultaneously turned-off by the religious focus of his wife; indeed, by now he had become sceptical of organized religion, if not agnostic in his outlook. And, in the free time that his success afforded him, he worked-out and kept fit. As well as discovering a passion for history, philosophy, and science, he read voraciously for pleasure. The world of ideas had captured him.

The wife would encourage her husband to pray with her and to attend bible study groups, but his study of the history of religion made him doubt the authority of the documents that his wife accepted as the foundation of her world view. She was calmed by the certainty of her belief in God, while he had become a sceptic.

For her part, the increasing “intellectuality” of her husband and his decision to return to school for occasional classes left her untroubled, but unable to connect with his newly developed interests. His efforts to engage his wife in conversation about the things that he found intensely exciting found her indifferent, unable even to feign curiosity. That was simply not who she was.

And so they grew apart, although her life remained satisfactory to her, since she was not looking for the intellectual interaction that her husband wanted; or sex, for that matter, although she dutifully complied with his desire to continue a physical relationship with her. Other than the children and  the practical matters that occupy business partners or roommates, there wasn’t much depth of communication, and certainly no meeting of minds.

The woman did not sense the extent of her partner’s disaffection, his feeling of emptiness, or experience these feelings herself. She was close to the children while he had only business associates, no close friends. Nor was he one to talk about his feelings with her easily, so that his wife’s lack of intuition left her unaware of his loneliness and his desire to engage with someone who stimulated him in every sense.

Indeed, intensity was not what his wife wanted, not in bed, not in the world of ideas, not in thoughtful conversation about his feelings. When he did try to achieve these things with her, he was left even more disappointed than before.

Still attractive to women, with a strong personality, good looks, and the status conferred by money and power, he was tempted by younger, more admiring females who offered a sense of engagement that his wife seemed not to value. Still, the ethic of responsibility with which he was raised gave him pause, and he experienced a feeling of anticipatory guilt as he thought about the prospect of being unfaithful.

Whether this man acted on the temptation for an extra-marital affair or sought a divorce is not something I’d like to address quite yet. First, I want to raise some basic questions about relationships and responsibility:

1. Should this couple stay married for what might be another 40 or more years?

2. Is it possible that the idea of fidelity — the promise of a lifetime of faithfulness — made more sense when lives were shorter than they are today? The average lifespan of 50 at the turn of the 20th century has now been extended, at least in this country, to the mid-70s for men, and even longer for women.

3. How much should we be held accountable for a decision (to marry) made at a relatively early age that does not — cannot — fully anticipate the unpredictability of changes in personality, behavior, and beliefs that may occur in any life?

4. To what degree should one member of a marital couple sacrifice his or her happiness so that the other member remains satisfied and content?

So what happened?

The female was not interested in marital therapy (although she did give it a half-hearted effort), instead believing that it was her husband’s lack of religious faith that should be the target of intervention, and that only if he was properly devoted to God would he be relieved of his troubles. He eventually did have affairs, but when his wife found out he saw what injury he had done to her, felt guilty, and renounced infidelity (and the divorce he also contemplated) going forward.

The husband attempted to accept his wife’s limited interests in the things that stoked his imagination. In his mind he had already hurt her enough and therefore could not demand more.

This woman was now, once again, contented in her life, if ever mindful of her husband’s potential for further betrayal, of which she did not hesitate to remind him. The couple stayed in their rural suburban community away from the stimulus of the city that he craved, partly as his penance for harming her, and partly (she hoped) to keep him away from temptation. He did not again pursue other women or respond to their attempts to entice him.

Later, as his involvement in the world of business began to wind down he suffered a diminished and unsatisfactory life, relieved only by the self-stimulation of reading, his increased closeness to the children he had left for his wife to raise while he pursued the bread-winner role, the grandchildren who received the best of him (as his children had not), and the joy that came with being an active part of their small lives.

Most of us know at least one old friend, someone we hardly ever see anymore, with whom we somehow remain close. “We pick up wherever we left off, even though we haven’t seen each other in years,” or so we say in such situations. But we also know the experience of growing apart from a person we might even see fairly often.

In the first instance we have taken different routes in life, lived away from each other, but wound up in the same psychological, intellectual, and emotional place. In the second example, even though our external paths have not differed very much, our internal compasses led in different directions. We may be close by, but we are no longer close.

The relationship problems exemplified by the couple that I’ve described grew out of the divergence of these two human personalities as time passed. It would be easy to see one partner as evil and one as good, but I hope that it is clear that this situation was more complicated than that. The husband was not cruel. He did not wish to harm his wife and, in the end, was clearly leading the less happy life of the pair.

He had sought fulfillment by pursuing other women, at least temporarily. But did not his wife pursue her own self-interest, as well? It included a kind of marriage between herself and an institution of faith — the church and the people who made it up. That it did not involve sexual infidelity, however, does not mean that it had no effect on her husband. Indeed, he craved an intellectual, emotional, and physical exhilaration that his wife found unnecessary to her well-being.

It could be argued that in ultimately choosing fidelity to his wife, forsaking the kind of betrayal he had visited upon her earlier, the man had betrayed himself and the possibility of a satisfying companionship for himself ever after.

Life does not always easily correspond to neat categories of right and wrong, good and evil. Even the Ten Commandments are not seen as absolute by most Christians and Jews, at least those who justify killing in wartime or self-defense, or accept the State’s right to perform capital punishment.

Sometimes people who once matched well, change. Sometimes you can do nothing wrong and get an unfortunate result. Sometimes the choices that partners make prohibit mutual satisfaction because of who they are, not because one is good and one is bad. A relationship that works for both parties today may not continue to work indefinitely.

It is a bit unsettling to look at life this way.

But that is the way it looks from here.

The image above is American Gothic by Grant Wood, sourced from Wikimedia Commons.

Violence and Intimacy

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Perhaps it shouldn’t surprise us, but one can do the most violence to another when one is close to that person. Physically close. Pinching, punching, pushing, plucking, picking, pulverizing — actions that can only be done at close quarters, the victim is pilloried and punished. Perhaps then, it is no wonder that human kind can be uncomfortable with and afraid of intimacy.

When physical vulnerability is compounded with the psychological, we tend to be even more careful. Those who are close to us know just where to strike, where the soft and breakable parts are; and they are just in reach.

I watched a History Channel feature the other night on The St. Valentine’s Day Massacre. The point was made that while the Thompson submachine gun was a useful weapon for killing at a distance, many of the most important gangland assassinations were done with a pistol, while holding or grabbing the victim, or pulling him close to make certain that he couldn’t reach for his own weapon. Intimacy again — the closeness that made injury possible, more certain, more lethal.

Remember Delilah of the famous bible story that featured Samson? Again, intimacy, this time of a sexual nature, allowed her to rob Samson of his strength by having his enemies cut his long hair while he slept.

When you were a kid, do you remember an aunt or uncle or grandparent who would hold you close and then pinch (and shake) your cheek between thumb and forefinger? It was alleged to be an act of affection, but whenever it was done to me, I couldn’t quite understand how something that hurt that much was supposed to show love.

I’m sure you know the origin of the handshake — an ancient custom designed to display the fact that you do not have a weapon in your hand with which to do injury at close range.

And, in the “you always hurt the one you love” department, we should not forget that “crimes of passion” account for many of the violent deaths in this country. That is, we are harming those we know, not strangers, in fits of intense emotion and impulsivity.

How does this relate to therapy? In part, because the therapeutic relationship is a somewhat one-sided intimacy. The patient makes himself vulnerable to the doctor, displays his wounds and expresses his emotions, trusting that his secrets and feelings will be safeguarded, treated with kindness and respect, and definitely not used against him. Therapists need to keep this in mind, lest they re-traumatize the person, injuring him in a way that is similar to the very torment that he came to therapy to heal.

Although a counselor’s power can hardly be considered “great,” it is considerable when it comes to his patients. Psychologists would do well to remember the quote from the movie Spider-man: “With great power comes great responsibility.”

The moral of the story? Allowing one self to become close and vulnerable to another person opens the door to the best and worst that life can offer. It is therefore of great import to choose a friend, a lover, or a therapist with care.

As the Knight Templar told Indiana Jones in Indiana Jones and the Last Crusade when the explorer had to pick out the Holy Grail from an assortment of old cups, “choose wisely.”

The above image is William-Adolphe Bouguereau’s 1850 painting Dante and Virgil in Hell sourced from Wikimedia Commons.

Parenting: When Love is Not Enough

madame roulin with her baby marcelle by vincent van gogh

Well meaning parents don’t always do well.

Or, to put it more bluntly, you can mess up your children without really trying.

Take the following example: two caring, well-educated, good people. They were in love with each other and loving toward their children.

One child was handsome, outgoing, and had a sunny disposition. Other children and adults were drawn to him. He awoke every morning with a smile on his face and brought cheer to those around him. Although not a great student, this boy was certainly bright enough; he made his way more than adequately in the world of friendship, study, and eventually, work.

His brother, however, did not have it so easy. To start, his body was ungainly. Even as a kid, he lumbered and lurched in locomotion. His cumbersome, block-like (not overweight) form caused him to stand out. Because of  a lack of refined adroitness in matters of balance and dexterity, he was always the last boy picked in the choosing of teams on the playground and in the gym class.

To the good, he was astonishingly bright and intellectually curious, but this only fueled the separateness he felt, to which his graceless body also contributed. Outgoing though he was, peers tended to shun and ridicule him. Social skills did not come instinctively and this young boy’s efforts at outreach neglected the usual questions that facilitate social contact: queries like “How are you?” or “What did you do over the weekend?”

Monologues rather than conversations were the result, further emphasizing this kid’s peculiarity and securing his status as an outsider.

His parents were at a loss. Certainly, they treated their dear son with kindness and affection, and applauded his prodigious intellect and curiosity about the world. But, when they saw his unhappiness and discovered that peers marginalized and ridiculed him, each of the parents tried to put a good face on things. While they defended him when they actually witnessed the cruelty he received, the boy’s hurt was not discussed very much at home. The parents minimized or ignored his pain, believing it best to encourage him to believe that things would soon get better and telling him not to let the ill-treatment of the other children bother him.

Soon enough, this child tended to his wounds by himself, confiding little in his parents, as if he instinctively realized that they would not or could not offer him any response that would feel good. Those times late at night, often just before bed, when a child is most vulnerable and open to spill his pain, passed without the flow of consolation. Thus, like many children (especially boys) who find themselves feeling empty and alone, deadening his emotions was preferable to exposing his heart to further injury.

To be fair, mom and dad figured that their boy would come to them if he needed or wanted to talk, and read his attempts to kill his emotions as a lack of need for the solace that can be achieved by having a shoulder to cry on. Indeed, they thought that he would be angered by any attempt to invade his privacy and bring up uncomfortable topics.

Nor did the elders provide guidance in how to be more reciprocal with people or give him direction in how to create conversations rather than monologues. They never pointed out that it was important to show interest in what others were doing or saying, despite the fact that both of them routinely displayed this with their children and in their own social lives. Instead, the parents reasoned that their son was already feeling hurt and rejected; and they feared that they might injure him further by telling him that his conversational style could be improved.

By the time of his adulthood, our subject had become what one might expect based on his early life. Surpassingly bright, he went to an elite college and had a coterie of those who admired his intellect and creativity, but no real friends. The pain of rejection had long since been pushed down deep inside, to the point that he might not have recognized the need or value of “closeness.” He was as out of touch with the emotional side of his own life as he was with the feelings of his conversational partners. Our young man seemed to have little need to find out about what was going on “inside.” Nor did he understand that his failure to ask questions to peers could be seen as arrogance, indifference, or peculiarity.

Still, our youthful gentleman led an interesting life because he sought out intellectual stimulation and threw himself into numerous activities within the world of the sciences and the arts. But, it remained a solitary existence, even if it was no longer clear to what extent he felt marginalized, so cut-off did he seem from the matters that connect head and heart.

His parents still tried to put a good face on their son’s way of living, as much as they knew about it, since they continued to be hesitant to ask him sensitive questions. But deep down they wondered whether he could possibly have any close friends (not to mention lovers) given his way of talking to people. Even now they felt that it was too late to bring up things that might cause him pain or trigger his anger at them for prying into his life.

Instead, the parents would occasionally comment to friends about their unusual son, make good-natured jokes about him, and simultaneously take enormous pride in his considerable intellectual and vocational success in the very stimulating, if strangely disconnected life he had fashioned for himself.

In defense of the elders, it should first be said that they could have done much worse. Their son didn’t do drugs, steal cars, embezzle money, or trip old people crossing the street. They parented him instinctively, as most of us do with our children. They certainly did not want to hurt him but, in their tiptoeing around his emotional pain, they failed to recognize opportunities to provide needed consolation and guidance concerning the social skill he lacked.

One can imagine that things could have been different. Had the parents been comforting and validating of his early humiliations rather than choosing to minimize them, perhaps he would have felt less isolated and not cordoned off his feelings even from himself. Had mom and dad gently guided him in how to converse, he might have had more social success and seemed less odd because of his penchant to prattle on about himself. If the parents encouraged their child to salve his own and others’ unhappiness by first providing that soothing themselves, maybe intimate relationships would have flourished.

It is impossible to know for sure. Child-rearing isn’t like a laboratory experiment, with an experimental and a control group. The “what if” questions are never answered with certainty. Sometimes nature has its way, no matter a guardian’s best and most understanding efforts at nurture.

Raising children isn’t easy. If you are lucky, you have a child like these parents’ first born, who responded well to the instinctive default parenting style of mom and dad.

But, for those of you who have more than one child, it quickly should become clear that they do not come out of the womb as identical sprouts, each needing just the same amount of sun, temperature, water, and nutrition. No horticulturist would treat a tropical plant in the same way that we would care for one that can only flourish in a more temperate climate.

And yet, even today, parents too often believe that “one size parenting” fits all children, and that it is the child’s job to adapt to the parents’ approach to upbringing rather than the other way around.

Put another way, you can be a good parent to one child and a less-than-good parent for another, simply by taking the identical approach to each of them.

The rule is simple: be the parent your child needs you to be.

Search yourself. Ask what your offspring requires. What will work best for this particular little human being?

Then, if you discover that the required approach to child-rearing doesn’t come easily to you, learn and stretch yourself.

You are responsible for a human life.

No job in the world is as important.

The above image is Vincent van Gogh’s Mother Roulin With Her Baby.

Off to College and Saying Goodbye

Paintings Reproductions David, Jacques -Louis The Farewell of  Telemachus and Eucharis

It is that time of year. Some kids are going to college for the first time. A difficult moment for all concerned.

If you are a parent, your child may have been spending much of the last year or two pushing you away; being disagreeable; wanting to spend more time alone; confiding in you less.

It could be adolescent rebellion in a fairly moderate form, but, more likely, it is his striving for independence; and his anticipation of the real break — the one that finds him living in a different state; both a state of mind and a State of the Union.

As most of us know, it usually feels better to be the one who ends a relationship first or enacts a change in it — separates, creates a distance — than to be on the receiving end of that action. But, whatever it is, it is tough for sure.

The farewells can be tearful and terrifying, mostly for parents. The kids have their anxieties too, but don’t want to betray them as openly as the elders do. The students’ brave front is as much to persuade themselves that everything will be fine outside the nest as to keep their ambivalence in check, lest they encourage mom and dad to show even more emotion and make the parting harder.

I remember spending a good portion of our drive back home from an off-to-college goodbye with tears in my eyes, having taken our eldest to the Champaign/Urbana campus of the University of Illinois. Within a few days we heard from her though. Sure enough, homesickness.

Letting go of your children is hard, as I’ve written elsewhere on this blog. You have to have faith that your offspring have learned something by age 18 and that they will survive, bruised but unbowed. Not much you can do anyway, unless you are prepared to keep them hostage in your basement forever.

They will return of course, but they won’t be the same. That too is a good, if  ambivalent thing, a sword that cuts both ways. As a parent, you’ll remember the cuddly and loving stage, the moment when you were everything to them and they couldn’t get enough of you. In trade, you get to see your children flourish (one hopes) as adults, a wondrous thing when you remember back to how little and helpless they once were.

But, be patient. The “full bloom” just might take some time and some struggle. Keep the faith.

Regardless, you do get more peace, quiet, and privacy as a bonus.

A new relationship, then — something different rather than better or worse.

The “saying goodbye” comes by degrees. At first, they return for summer vacation and holidays. Later, they will live away and see you less often. Such is life.

My wife and I kept a very old car for our daughters to use when they were home, even after both had graduated college and gone on to grad school. Finally, a minor accident rendered it beyond repair and we donated it to charity.

For a few days after the auto had been taken away, my wife and I both felt a little bit low. We talked about it. Of course, it wasn’t hard to figure out. The car was a symbol, something tied to the time they lived with us, and something that said they would be coming back. Now, with the car gone, we both had to face  that there was no coming back with the regularity of the past.

Their lives were elsewhere.

When I gave the toast at my eldest’s wedding, I told the following story:

I remember the day that we took Jorie to Champaign/Urbana to the Illini Towers dorm, to begin her college education at the University of Illinois. We thought we would be clever about it, so we woke up very early that Saturday morning and drove fast so that we would be among the first to get into the building and unloaded. But we were out foxed by several hundred people, who had gotten up earlier and driven faster and were already way ahead of us in line to use the couple of elevators and the small number of carts to get their child moved in.

It was a long, hot, late summer day. And as we stood in line  waiting, I had a feeling of familiarity, as if I had done this before. Of course, I had never moved Jorie into any new place, so I couldn’t easily figure it out.

As the morning changed to afternoon (and we were still in line), I thought back to the day that Jorie was born. At 1:00 AM, that is to say, in the dead of night, Jorie gave the signal and we were off to the hospital. And that too was a long day as we waited for the labor to progress. Finally, at 9:34 PM, over 20 hours later, Jorie arrived in this new world. And I realized that the long day of waiting for her to be born was what the long day of waiting at Illini Towers reminded me of.

The only difference was that on that day at the hospital we were waiting to say hello to her, and on the day at Illini Towers we were waiting to say goodbye.

Shakespeare was right.

“Parting is such sweet sorrow.”

But, life does go on.

The image above is The Farewell of Telemachus and Eucharis by Jacques-Louis David.

War Requiem

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War — the cost of war — seems worth consideration on the occasion of Memorial Day 2010. Perhaps you have seen the movie Brothers. It will be in the same spirit, I hope, that I reflect a bit on the cost that any war brings, however necessary it might be. I will do this by quoting two poems and directing you to some wonderful music using poetry as text.

World War I,  “a war to end all wars” according to President Woodrow Wilson, generated lots of verse. British poets, in particular, found the pity in wartime, and as Wilfred Owen wrote, “the poetry is in the pity.” Owen fought and wrote about fighting, as in a letter to his mother just after his arrival in France:

“I can see no excuse for deceiving you about these 4 days. I have suffered seventh hell.

I have not been at the front.

I have been in front of it.”

The 25 year-old Owen was to die in battle just one week before the armistice on November 11, 1918.

When Benjamin Britten, the pacifist English composer, was commissioned to write music in honor of the reconsecration of Coventry Cathedral in 1962 (which had been destroyed in World War II), it was Owen’s World War I poetry and the Latin Mass for the Dead to which he turned. The piece, for large orchestra (with the addition of a chamber orchestra), three vocal soloists, and chorus, alternately rages against and laments the ravages of wartime.

The War Requiem ends with the Owen poem Strange Meeting, sung at the première by an English tenor and a German baritone, no coincidence as England and Germany fought against each other in both World Wars.

In this poem (excerpted below), the narrator finds himself in the bomb shelter and sleeping quarters below the trenches of the enemy, “down some profound dull tunnel,” as part of a night raid where he encounters dead and dying soldiers. There, he and his enemy recognize their shared human bond:

…Then, as I probed them, one sprang up, and stared
With piteous recognition in fixed eyes,
Lifting distressful hands as if to bless.
And by his smile, I knew that sullen hall
By his dead smile I knew we stood in Hell

“Strange friend, ” I said, “here is no cause to mourn.”
“None,” said the other, “save the undone years, the hopelessness.
Whatever hope is yours, was my life also…
For by my glee might many men have laughed,
And of my weeping something had been left,
Which must die now. I mean the truth untold,
The pity of war, the pity war distilled.
Now men will go content with what we spoiled,
Or, discontent, boil bloody, and be spilled…

I am the enemy you killed, my friend.
I knew you in this dark: for so you frowned
Yesterday through me as you jabbed and killed.
I parried; but my hands were loath and cold.
Let us sleep now…”

The English language changed because of World War I. Phrases and references to the word “trench” became part of common parlance, as in the phrase “in the trenches” which still refers to working at a hard, grinding task; and even the phrase “trench foot,” which led back to a type of frost bite common in the muddy, cold, wet, and verminous condition of those dark places inhabited by the warriors.

Or, how about “trench fever,” a bacterial infection associated with the lice that bred there. The expression “No Man’s Land,” plays back to the space between the trenches — between you and the enemy trench — which could be a few hundred yards. It was the place belonging to “no man” or side in the conflict, and it was the place where no man could easily survive. So too, when one army decided to launch an attack on the other, they had to go “over the top” of the trench and into hostile fire.

But it was to a much earlier use of the trench in warfare that the poet Patrick Shaw-Stewart would refer.

Patrick Shaw-Stewart was born on 17 August 1888 in Wales, and fought as part of the British Expeditionary Force at Gallipoli on the Chersonese peninsula during World War I, not far from the site of the Trojan War.

Gallipoli was a disaster for the British. Shaw-Stewart was on three days leave from the front on the island of Imbros when he wrote the untitled poem that follows. It refers to the Trojan War as represented in The Iliad, so a little background is required to better understand it.

The war began soon after the Trojan prince Paris abducted Helen, the most beautiful woman in the world, but the wife of one of the Greek kings (Menelaus). The Greeks organized their own expeditionary force and followed Helen to Troy so they might retrieve her.

Many years into the conflict, Achilles, the greatest of the Greek warriors, stopped fighting because the leader of the Greeks (Agamemnon) had taken away Achilles’ concubine. Achilles’ rage and his decision not to fight is called “The Wrath of Achilles.” In addition, Achilles knew if he returned to battle he would not survive the war. Despite this, he resumed the fight and turned its tide, with the goddess Athena beside him, both shouting in a trumpet-like, horror-inducing scream to make the Trojans flee.

Achilles and Athena stood at the ditch in front of the wall built by the Greeks to protect their ships. Achilles’ head was surrounded by an aura of flame created by the goddess (to which the poet refers in the heart breaking last stanza), so better to terrify the Trojans, who panicked and ran away.

Shaw-Stewart tells his own Illiad-like war story from the standpoint of his temporary leave from fighting:

I saw a man this morning
Who did not wish to die
I ask, and cannot answer,
If otherwise wish I.

Fair broke the day this morning
Against the Dardanelles ;
The breeze blew soft, the morn’s cheeks
Were cold as cold sea-shells

But other shells are waiting
Across the Aegean sea,
Shrapnel and high explosive,
Shells and hells for me.

O hell of ships and cities,
Hell of men like me,
Fatal second Helen,
Why must I follow thee?

Achilles came to Troyland
And I to Chersonese :
He turned from wrath to battle,
And I from three days’ peace.

Was it so hard, Achilles,
So very hard to die?
Thou knewest and I know not-
So much the happier I.

I will go back this morning
From Imbros over the sea;
Stand in the trench, Achilles,
Flame-capped, and shout for me.

Much like Achilles, Patrick Shaw-Stewart survived the Gallipoli campaign, but not the war.

He was 29 at the time of his death.

Fear of Change: the Therapeutic Implications of Japanese Holdouts

Onoda-young.jpg

Things change. The question is, do we change with them? Or, do we instead, continue to operate by the same outdated rules of conduct.

I often said to my patients that they seemed to be behaving as if the conditions of their early life still existed. They had long since fashioned solutions to problems that they faced many years ago, and continued to use the same solutions, even though those methods of living didn’t fit with their current life situation. It is as if one were born in Alaska, learned to wear multiple layers of heavy clothing and then moved to the tropics without a change of attire. The warm clothes were helpful up North, but are a disaster down South.

What does this have to do with the “Japanese Holdouts of World War II? The answer is that these men lived by an outdated set of rules with heartbreaking consequences.

If you recall your history lessons, you will remember that the Japanese soldiers of that period were trained according to the principles of Bushido, a feudal fighting code that derived from the period of Samurai warriors. Above all else, weakness was condemned and surrender was disgraceful. Death by one’s own hand was seen as preferable to permitting oneself to be captured, so as to avoid both personal disgrace and family shame.

The Allied approach to the war against these very soldiers in the Pacific was one that involved “island hopping.” The strategy passed over certain islands, both to save men and ensure that the Allies would be able  to capture those islands that were of the greatest strategic value. When the Japanese surrender came in 1945, numerous Japanese troops found themselves stranded on out-of-the-way Pacific islands, cut-off from their command, and without the capacity for communicating back home. These men neither knew the war was over nor could imagine that any honorable soldier, let alone their entire nation, would surrender. Some were in small groups who gradually died from disease or starvation; others were, at least eventually, alone.

While many never surrendered and died still waiting for reinforcements that never came, it was not uncommon in the late 1940s and 1950s to read news accounts of isolated Japanese combatants giving themselves up. The photo at the top of this page is of Second Lieutenant Hiroo Onada, who finally surrendered in 1974, and would not do so until his former commanding officer, by then a bookseller, personally ordered him to lay down his arms.  At that point, World War II had been over for nearly 30 years.

Thirty years. Yes, 30 years dedicated to a war that was over and a life of desperation that was no longer required.

But how many years, if any, have you given up to a thread-bare, bankrupt strategy of living that has long since outlived its usefulness?. And, more to the point, how many more will you endure? When will you realize that your “solution” has now become the problem?

In my psychotherapy practice I saw numerous variations on this theme. People who were abused or neglected  or criticized as children and who continued to live in terror of disappointing others. Those who found substance abuse the only available way of treating the depression or anxiety they experienced when they were young, and who continued to do so. People who avoided challenges because they were scared of failure, having failed many times in the past. Individuals who wore a chip on their shoulder, forever sensitive to insults and injuries that reminded them of long ago attacks, but now were only injurious in their imagination. And those poor souls who expected rejection because of past rejection. Like the Japanese holdouts, the years pass but the fear doesn’t, and the possibility of satisfying relationships and happiness slips away.

If you still are responding to the present as if it were the past, with solutions that solve little (even if they were once necessary), then it is time to change your life. The barricade of your life’s defenses might be protecting you only from the phantom of an enemy who lives within you, not on the other side of the fortification.

A good therapist is likely to be able to help you develop a new way of living, one more appropriate to the world as it is, not the world as it was; to set aside and heal old wounds.

Is it time?

What is the continuation of your old way of living costing you?

The war, your personal war, might just be over and you don’t know it.

Moms on Mother’s Day

Nurturing, caring, loving, concerned, patient, compassionate, expressive, reliable, watchful, tender, giving, interested, independent, graceful, affectionate, accepting, enthusiastic, encouraging, strong, wise, and kind

or

preoccupied, worried, stressed, indifferent, cold, selfish, shrill, overwhelmed, judgmental, angry, impulsive, erratic, hard, numb, inconsistent, weak, troubled, vain, dependent, clumsy, clueless, and cruel.

As a parent and as a child, here’s hoping you came out and come out on the right side of this.

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Rest on the Flight Into Egypt (detail) by Caravaggio