When Adult Children Shun Their Parents

Over on Shrink Rap News, a post will be going up about my random thoughts about adult children who essentially divorce their parents.  In the families I'm talking about (and I know many), these aren't extreme situations--the children did not suffer from abuse, neglect, or deprivation at the hands of their parents.  When they were children, the parents tried to be attentive, caring, and to provide for them as best as they could (which was sometimes rather well).    The parents likely made mistakes, because parents are not perfect,  but the issues are current ones...and often ones the parents themselves can't articulate.  In these cases, the adult children have severed ties even though the relationship was close, and they themselves might say they had good childhoods.  Why the estrangement?  I suppose it's different in each case, and often there are issues with parental divorce, the relationship with the child's spouse, a sense that the parent is too critical, too judgmental, or perhaps too intrusive and controlling.  The adult children may feel they are being used or manipulated.  I talk about some of my theories, and they may well all be wrong.  None of it science, just what I've gathered from listening.  If you'd like to read my thoughts, I invite you to surf over to CPN's Shrink Rap News.  And, of course, I'd like to hear your story.  You can check over there sometime around noon.

If you're interested, I'll also direct you to a website run by someone dear to me:  MOTHERRR! -- about rebuilding mother-daughter relationships.  While my post talks about estrangement from the vantage point of the parents, this site looks as mother-daughter difficulties from the perspective of the adult child. 
  

Podcast 56: It's All Your Mother's Fault

Oh, not really.
In this episode, we talk about parenting. Now why do we talk about parenting: this is a psychiatry podcast, did someone forget to tell us that?

We talked about parenting for a few reasons:

It started with the tie in between trying to understand how mentally ill people become violent and we mentioned the very poignant article that Susan Klebold wrote on Oprah.com called "I Will Never Know Why?" about her son's role in the Columbine shootings and the awful toll this has taken on her. Somewhere, as a society, we've decided that parents are responsible for how their children turn out, and parenting topics are frequently addressed by patients in psychotherapy. We hear from patients who feel wronged by their parents and from parents who worry about doing right by their children. Ah, if only we had crystal balls!

This led us to talk about Amy Chua, the Yale attorney who wrote Battle Hymn of the Tiger Mom and whose article "Why Chinese Mothers are Superior" in the Wall Street Journal has gotten everyone talking about parenting styles of the East versus the West. Is this a good thing or does it contribute to student suicide?

We also mentioned Dr. Richard Friedman's article from the New York Times, "Accepting that Good Parents May Plant Bad Seeds" and Susan Reimer's article in the Baltimore Sun, "Blame Jared Loughner's Parents--It's the Easy Way Out."

Mostly we talk about the uncertainty of it all and mention issues related to good-enough parenting, lousy parents who get resilient kids, and good parents who get lousy kids.

Thank you for listening. Please do write a review on iTunes!

****************************

This podcast is available on iTunes or as an RSS feed orFeedburner feed. You can also listen to or download the .mp3or the MPEG-4 file from mythreeshrinks.com.

Thank you for listening

Send your questions and comments to: mythreeshrinksATgmailDOTcom

Facebook Undone

Today I was friended by psychiatrist friend I haven't seen in a while. She's in her 80's and has always been pretty technologically savvy. I told one of my teenagers, who has met this friend in real life, and she (the teenager) told me she didn't want to hear it! Huh, you aren't interested in my Facebook life?

"People don't talk about what happens on Facebook."

Huh? Neat stuff happens on Facebook, why can't I talk about it?

Well, I got an earful. You talk about what happens on FB, because then it's like you don't have a real life, and people will think you're pathetic, and this will push away the real people in your life who now think you're rather dismal and all you have to talk about is your virtual life because you have no real life to talk about, and then you'll have less people in your real life and you'll need Facebook even more, and it's a vicious cycle.

Mostly likely, I'm doomed.

In Treatment, Season 2, Episodes 3, 4 & 5

Paul is videochatting with his son. The boy is animated, but Paul stops him for an inquisition about that C in writing. The doorbell rings and Paul has to go-- yup, it's Oliver's mom, here to collect the forgotten Turtle (and ClinkShrink does indeed like turtles).

Family therapy session with the dissolving family: Oliver had a great time staying with his dad, Luke, and we discover that Luke is dating Nina. Oh, and Nina is Oliver's former teacher, and she's 23. This doesn't sit well with Bess, and Paul takes Oliver out into the waiting room where the two of them talk while Bess and Luke fight it out in the main office. We hear how Oliver feels alone, doesn't feel at home anywhere, and how he thinks Paul has a son. He assumes Paul is divorced, that his son lives with his mom, and Oliver wants to meet Paul's son. Paul must be a good dad because he listens, and I'm struck by the poignance of the moment. Paul listens so much better to Oliver than he does to his own child. When Oliver talks about missing his mom, you can almost feel Paul missing his son and at the same time missing his own long-dead mother. Family parallels are everywhere. We also hear about the adoption of a sibling for Oliver-- a process started but never finished.

Back in the office, Bess and Paul are still alive. I'm not sure I would have left them alone given the hostility between them at this time.
-------------
Cashmere Walter is beside himself about a recall at work. He's 2 hours late, he tries to give money to Paul, and he's all worked up. Paul tries to interrupt Walter, but he can't be redirected. He's wired, the phones/blackberries/iPhones are ringing out Walter's pockets; he's too busy to drink water. Paul suggests they reschedule after the crisis. Walter calms down, turns the gadgets off, and drinks some water.

So Walter has just returned from a trip to Rwanda to get his daughter. She cut her hair (Paul can relate-- "that's what daughters do.") Walter fights with his daughter, he tells her she's coming home with him, and she curses him out. "She broke my heart." "It turns out that I'm domineering, obsessive, the cause of all her problems...I'm ruining her only chance to free herself from me....Now you know why I went over there."

Paul points out to Walter how uncomfortable he is when he's not in control. Paul points out how hard it is for Walter to let his daughter go. Walter jumps up and takes a Xanax. He talks about a panic attack he had in Rwanda where he woke up thinking he was in his brother's room--the one who died as a teenager. Paul draws a comparison between Walter's loss of his brother and his feared loss of his daughter. Walter doesn't want to hear it. The man has a overwhelming need to be indispensible.
-----------------------
Paul wakes up with a woman-- ah, he's been sleeping with Tammy Kent and he'd promised Gina he wouldn't. Paul's daughter Rosie calls, she's worried about her grandfather, Paul's dad, and he dismisses her concerns. Rosie hangs up on him. Later same day, now in Maryland instead of Brooklyn, and Tammy and Paul bump into each other in Gina's waiting room.

Paul announces that his dad is very sick and Gina says, "I'm so sorry to hear, Paul." Paul responds, "That's so easy to say." I cringe a little, because when anyone tells me about something troubling that's happened, I tend to say, "I'm sorry." Not as an apology, but as a statement of regret. What should Gina say? Paul goes on to talk about his sick father in a nursing home. "He was never present in my life."

Paul tells Gina he met with Tammy to discuss his memories of the Christmas Eve when his mother tried to commit suicide. Tammy had different memories...she says that his dad was there, and Gina begins to question Paul's memories and his description of the past. "We're constantly altering our memories so that the past is consistant with the present." Paul has a script of what happens where he ascribes intent to his father's actions-- Gina suggests that the father's intentions might have been different. Gina draws parallels between Paul's father and Paul's current situation, and this angers him. "No wonder my patients complain about this. Will you stop repeating everything I say!" They talk about the events of the past, of how Paul's mother had bipolar disorder. Paul talks about wanting to save his little patient, Oliver, and how he relates to Oliver's difficulty being with his father. Paul talks about how he should go see his father, and how he should talk to his own kids.

Generations of parallels, his patients', his own, and all that isn't being said about how Paul betrayed Gina's trust by sleeping with another patient when he promised he wouldn't. Gina has her own doorknob moment. "And next week, we'll talk about Tammy."

The Snake Trail Test

Psychiatrists have a way of assessing judgment during the mental status examination. Typically they'll ask a question like, "If you found an envelope lying on the sidewalk and it was addressed and stamped, what would you do with it?" The typical answer, the one that will get you a 'good' rating on the judgment line, is: "I'd mail it." Duh. There are other possible responses, some of them more interesting or creative than others, but that's the response you get most of the time.

I had a chance to come up with a new "judging judgment" type question this week. I call it the Snake Trail Test. Here's how I came up with it:

As coincidence would have it, one of the best local climbing spots near here also happens to be a repository for copperhead snakes. Since I've taken up climbing I've now seen more copperheads in the wild than I've ever seen in any zoo. Whenever I see a snake, I warn any hikers I happen to see in the area. Many hikers are parents with small children. It's been interesting to see the wide variety of responses.

One parent immediately grabbed the kid and said, "No no honey, don't go down that way. We'll go on this trail instead." Another parent still went down the trail, but cautioned the kids and made sure they stayed on the far side of the path, away from where the snake was spotted. The most interesting reaction came yesterday, from a young tattooed woman hiking with four kids under the age of ten. After I gave her the warning she shrugged, pointed back over her shoulder at the trail she had just come down, and said, "Yeah there's another one back there." Not a word to the kids and they all scrambled on without a care.

The psychiatrist within me thought: "Checkmark for 'poor' judgment." Then I thought again: "Maybe she's an herpetologist. Maybe she comes from a charismatic poisonous snake-handling cult. Maybe she's been hiking here for 20 years, has seen lots of snakes and never had a bad outcome." There were a lot of reasons why someone might not be freaked out by the idea of a poisonous snake in the trail.

My new Snake Trail Test has got me thinking about how we interpret judgment.

Judgment is formed through learning, experience, culture and a multitude of other personal idiosyncratic factors that a psychiatrist might or might not be aware of. The best way to sort out 'normal' and 'impaired' judgment is to ask followup questions. "Why would you do that?" is a good one. "Why not do this?" is another good followup question.

I didn't have a chance to ask the tattooed lady more questions, but I bet if I did she might have given me a good education about snakes.
___________
Note from Dinah: Here's a post from Edwin Leap about what Not to bring to the ER with you, and it includes the snake that bit you.

Dear Fat Doctor

Fat Doctor wrote a post a while back where she worries that her darling toddler son will some day be embarrassed by her weight problem. I meant to comment, I meant to write her, instead I'll put up a blog letter.

First a disclaimer: all kids are different, they come in assorted shapes, sizes, and temperments and I've learned quickly and painfully that a wonderful kid can become a particularly difficult kid-- this with a six week countdown in my family until such kid moves half way across the country to start college. Last year, I thought I'd have a nervous breakdown when he left, this year, he's making it a bit easier to say goodbye, though I'm well aware that I still may have a very difficult time with this departure. There are more difficult kids, there are easier kids. So with two teenagers, and with many friends (and patients) with teenagers, let me write a letter to our dear friend Fat Doctor in the blogosphere.

Dear Fat Doctor,

Please don't worry that your son will be embarrassed by your weight. He won't be. And because he's a boy, he probably won't care what you wear. Kids don't worry so much about what their mothers look like, oh, except for girls, who are known to yell: You Can't Go Out Looking Like That! Especially not where their friends might on the same planet.

While you don't need to worry about your son being embarrassed by your weight, there are a few things he will be embarrassed about.

• Your mere existence.

• Every word you say.

• Especially words that date you. Gosh darn is probably not real cool.

• References to TV shows, movies, politics, or events from the days of old.

• The music you listen to.

• The songs you hum. Oh, gosh, don't hum.

• The gestures you make.

• The things you say about him, no matter how glowing. Don't talk about him. Ever.

• The fact that you greet his friends. Do you really need to ask how they are and interrogate them about what they are doing and what they'd like to drink?
  

• The fact that you are not invisible.

• Your ideas. Especially if you express them.

• Oh, and your core beliefs, what ever they are, they are embarrassing.

• Your expectations of him.

This is only a partial list, but Son won't care about your weight. I hope this helps you sleep better.

With kind thoughts. By all means, continue to enjoy the next 10 wonderful years.
Dinah

The Journey Versus The Destination

In psychotherapy, people often talk about how they are disappointed with their station in life. By any given age, they should have had more toys, done more stuff, accomplished more More. Some people feel this way because the course of their life has varied a bit from what they'd mapped out-- maybe they didn't make it through college, maybe the love of their life disappointed them, maybe a bad break derailed them. Maybe they didn't like what they started out to do and changed paths a bunch of times in search of something more interesting.

I've taken to saying to these people (and I say it a lot) "For some people life is about the journey, for others it's about the destination. For you, it's about the journey." So what if someone hits 25 or 30 or 90 and they haven't finished college or they haven't finished law school or they aren't well up that longed-for (and often miserable) corporate ladder. If you aren't there, if you don't have the car/house/whatever you thought you'd have, it's disappointing and it causes a lot of preoccupation. I'll point out, however, that many people objectively have all the things one "should" have by whatever age, in the world's eye they have every measure of "success" and yet they still strive, still feel disappointed. There's always more money to be made, more toys to be had, another promotion that should have been gotten, more grants, more publications, the vacation home: a story of failure.

Why do we do this? Why are we always measuring ourselves and why have we set it so that some people are deemed failures (by themselves, by others). It's good if you can support yourself financially, it's good to be happy, enjoy the journey.

If my teenagers read this they would deem me the world's biggest hypocrite. They would be right. I am a destination person: I wrote my eighth grade career report on becoming a psychiatrist (I think I was going to do research at Duke running rats through mazes, but hey...). I went through college in three and a half years, went straight to medical school then residency, was a mom by 30, and I've encouraged (the older one would say "pushed") my kids to do well in school and strive. I struggle with a teenage boy who values television and video games and sees my life as a rat race. Last year he told me his "goal" was to win three-quarters of his on-line games. Oh, he's on the same trip (I think), off to college in the fall, but he'd rather not let anyone know.

So two more comments on journeys versus destinations:
One on the college application process--- oy! The kid filled in one application that had 5 essays: they included asking what professor he wanted to do research with, and "write page 217 of your 300 page autobiography." All the colleges asked what he had to add to ...diversity, life, whatever. It seemed like a lot of clarity, focus, accomplishment and form was wanted from a 16 year old boy. The college application process is a destination thing.

Second: yes, I really did write about wanting to be a psychiatrist when I was 13. Why? Yeah, why? I'd never met a psychiatrist, no one in my family is a doctor (much less a shrink), and I'd never met anyone with a mental illness. If anyone figures it out, please call me.

So: my take on it: Clink is a destination person, even if she does stop to smell the mushrooms. Roy is also mostly a destination person, but within the path, he swerves around a bit.

Good Parent Bad Parent

Last week, I wrote a post about Moms and Psychiatry; see "It's Your Mother's Fault".
People wrote in to say they had good moms, great moms, good dads, lousy dads. It got me thinking that there is an objective standard out there as to what makes a parent a good one (or even simply adequate). "I had a good mom" implies there is such a thing, but it seems to me that as with any given brand of ice cream, the issue of good versus bad is one of perception. Is there some one we all agree is a good mom? Carol Brady, perhaps? Perhaps it's more accurate to say that a person is a good mom for a particular kid, because it's hard to imagine, in my current state of teenage immersion, that there is someone our there who would be a great mom to every single kid.

I listen to a lot of parents. I listen to a lot of kids (not so just my own, but patients who are all someone's kids, though these "kids" range in age from 18 to 91). Here's what I've concluded.

There are some easy-going mild-tempered people out there who are are not terribly sensitive to exactly what is said or done to them, they are forgiving of bad days, perhaps even sympathetic to their parents' trials, and they don't tend to dwell on every grievance or imperfection their parents exhibit. These people tend to like their parents and tend to be happy people. This may be because they have perfect and wonderful parents, or it may be that they tune out their parents' mistakes.

In the absence of the super-easy going person who doesn't scrutinize their parents, I've found that kids and parents judge parenting by completely different standards.

Parents focus on what they've done for their kids, what material comforts and securities they've provided, especially if it exceeds what was provided for them. They focus on the amount of time and effort they put into forwarding their childrens' interests and education-- so getting up at 5 AM to take a kid to hockey seems like a sacrifice, and points should be earned towards the good parent award. Sitting on the side lines as a spectator to any musical/artistic/ theatrical/ or athletic event counts. Cooking special birthday meals, buying presents, allowing friends to overrun the house, these all counts. Extra points please for coaching teams, den mothers, snack parent organizers, lifeguarding at a home pool.

Children expect exemplary parents. Everyone else these days seems to have them, and they view life in a more "points off" standard. Everyone's dad coaches something, it's no big deal and effusive gratitude is not part of the deal. Children, however, know exactly what the perfect parent is : Mike and Carol Brady have set the standard--- remember that blended couple with the 6 kids from the 1970's where every problem got solved in a half-hour episode, no one talked back, and no child ever mentioned that one of their parents was a step-parent. Funny, those kids never missed their absent natural parent, and not once did a kid scream "You're not my real dad, you can't tell me what to do!" So kids dock you for losing your temper, saying things that objectively sound horrible---parents aren't allowed to call kids names no matter how extremely they are provoked. The translation goes "My mother used to tell me she hated me." Funny, the story never gets told as "My mother told me she hated me every time I cut up her good silk blouses to use for art projects." Okay, okay, even I don't think people should profess hatred for their kids, but I do think we've established a hard-to-attain standard for the Good Parent that leaves little wiggle room for the fact that parents are people too, and sometimes they react in impulsive ways: Points OFF, and no going back. Kids are kids, they're transgressions are part of the deal.

I talked to Clink about this the other night and she mentioned that good parents are Consistent. I thought about that. Children are moving targets, they come up with new antics (some of them fabulously amusing, some of them totally infuriating), and the moment you get the hang of it, they move on to the next developmental stage and the rules all fly out the window. So how do you be consistent when you're dealing with a target in perpetual motion?

Okay, so What's a Good Parent and What's a Bad Parent and why do some kids seem fine with people many of us would agree are awful parents while other kids feel tormented by parents who seem to be doing all the important things right? And should I even ask how much parenting steers how the child turns out? Maybe it's all in the chemicals, balanced or otherwise

It's Your Mother's Fault

Moms and psychiatry have a long history.

Freudian psychoanalysts like to talk about moms. "Tell me about your mother." Oh, those Oedipal sexual longings....

Winnecott, who gave us the concepts of the "holding environment" and the "transitional object" talked of the "Good enough mother"-- an imperfect creature who could still raise normal children.

Melanie Klein gave us the good breast, a way for the infant to internalize dear mama.

Bruno Bettleheim gave us those Refrigerator Mothers who caused their children to be autistic while Theodore Lidz gave us Schizophrenogenic Mothers. Oy.

I could go on and on, if only Roy would let me. While we've moved beyond blaming mothers for autism (now we have vaccines to blame until we name the next culprit-- please don't let it be chocolate), we still believe that mothering is a key ingredient in who a person becomes. Good mothers have good kids, bad kids must have bad mothers. No matter how you dice it, we all believe in cause and effect, and we all can write the script backwards. An entitled, self-centered criminal must have had a mother who spoiled him and didn't set limits. I remember my own mother saying, "When you see a child hitting someone, you know someone is hitting that child at home." (My mother read Dr. Spock, she wasn't a scientist).

It's really easy to write the story backwards, and in fact, as psychiatrists, that's what we do. As a mother (have I mentioned that I have two teenagers?) it's not so easy to write the story forwards. If I do "X" my child will become this type of person and if I do "Y" my child will become that type of person. It doesn't work that way, trust me. If it did, we'd all read the instruction manual and have a perfect world.

So this, I've decided, is the paradox of today's world, now that we are relieved of refrigerator mothers but not bad breasts: There are lots of things that society tells us we need to do for our children to grow them good. Mozart in the womb, and that's where it starts. No drugs, no tobacco, no caffeine, no artificial sweeteners, no alcohol: the perfect internal environment. And once they pop out, there are all sorts of do's and don'ts: what chemicals they inhale, what they watch (pg, pg-13, violence and sex and how long have you been sitting in front of that boob tube, junior?), how they behave, say please and thank you, not those violent video games and what are you watching on U-Tube? Montessori this, Rebounders that, chicken nuggets are good, chicken nuggets are bad, make sure they get enough sleep and not too much MySpace, quality time, licensed day care providers who build self-esteem, car seats and safety gates and all the right influences and none of the wrong. Talk to your kids, the TV says so, the billboards say so, talk to them about sex and drugs and God and country and the earlier the better (--see, I can go on and on).

Then they turn in to teenagers and they figure out that the word "controlling" is extremely pejorative in our culture. What's worse than a Controlling Mother? Even a bad breast doesn't sound so bad. Are you a controlling mother? What do you mean I have to eat vegetables? Or be home when? And that's the paradox.

In the world of teenagers and psychiatrists, it's hard to win as a mom.


You know you've been blogging a long time when....Roy followed me and added links in this post to past blog posts I've written-- I clicked on some of them and realized I don't even remember having written them. How does he? A man who needs a longer ToDo List!

Friends, Coffee, and of course, The New York Times Magazine

Happy New Year, everyone! As 2008 approaches, Roy, ClinkShrink and I will be meeting today (with the new & improved sound equipment) to record a podcast, and then I'm off to sip champagne on a warm and sunny beach. My friends, I trust, will hold the blog fort up.

So the other day, one of my kids asked me if I'd drive a bit and pick up one of their camp friends to spend the night. This child lives a fair distance and I've met only once, at a mall, when the two kids wanted to spend a little time together. This request was for me to pick the kid up, bring her home, and have her spend the night. A stranger to me, but a fellow camper to my child.

Some of my kids' friends see therapists and psychiatrists and take psychotropic medications. Some aren't so quiet it about it, I can be driving in a car and someone will pop out with "That's the building where my psychiatrist works!" Okay. But if they take medications while they're sleeping over my house, then I guess they do so quietly, no one's ever asked my assistance with any medication before. And a few, well, as they're jumping off my furniture in back flips, I just Know they must be taking Ritalin or something like it to get through the school day.

So I pick up the unknown camp kid and her mother hands me a bag of medications. I don't know mom, and I don't know the kid, and I don't imagine they know I'm a psychiatrist. "The instructions are on the bottles." Okay, I can do this.

The visit was uneventful, the child is lovely, patient with my kid who enlisted her help on an hours-long school project from Hell (don't ask, but if you're handy with a drill and have nothing better to do this afternoon, we could use your help here). As I handed the visitor her third mood stabilizer, I asked, "Do you feel differently if you don't take this?" "Not right away," she said.
--------------------------------------------------
And from today's Sunday New York Times Magazine and the recap of this year's The Lives They Lived Issue and some thoughts on mental illness:

Thomas F. Eagleton: The Running Mate Who Wasn't. Once his history of mental illness was revealed, his vice-presidential bid was over.
Marian Radke-Yarrow: The Anthropological Psychologist who studied the long-term effects of maternal unipolar and bipolar depression on the children of the afflicted.

and finally,
Allen Wheelis: A Neurotic's Neurotic a psychoanalyst writer who explored both his work and his own psyche. I'll give Dr. Wheelis, pictured above, the Shrink Rap quote of the day:

"I have not found in psychoanalysis the meaning I sought. I function as a guide to the lost, but do not myself know the way."

I Just Want To Talk

It's snowing here in Baltimore, it's kind of lovely. Victor, friend of our blog, told one of his classmates to sit down, it's only snow, and the boy told him he'd never seen snow before, they don't have it in his country of origin.

It's not 3:30 AM, but even in the daylight, I'm still worrying about my kid-- nothing awful, he had an issue at school and we feel he's gotten a bum rap at a time in his life when having a bum rap is hard, trying to rescue him from the unjust, and Roy is quick to tell me that life is unfair and it's a good lesson to learn early. I suppose. ClinkShrink and Roy both have things going on in their lives, Roy's working hard, I keep hoping he'll do the things I want him to do, but he's a guy who gets pulled in a lot of directions and judging by the long hours he tells me he's working, his hospital could use a few good shrinks. The blog is suffering a little, I hope not a lot. I haven't been visiting my usual blog friends and I hope everyone is well. I do peek at the results on our anti-psychotic poll and Seroquel is winning by a lot. If you haven't voted, please do.

Okay, so Roy did some Leopard thing this weekend. Yeah Leopard. Someday I'll be a Mac person, too. I'd kind of like an iTouch, but will I be able to get the information from my Palm Pilot over to it?? This story is for Roy: the psychiatrist across the hall from me also did tht iMac Leopard thing last week. Before he did, he backed stuff up, but still lost everything in his organizer-- he had to call 50 patients and ask them when their appointments were. Oh, and he did it twice.

With that thought, the judge in hair curlers sent me so cartoons that made me smile. I can share them with you?And finally, we three shrink rappers have been talking about distilling some stuff from the blog into a book. I suppose it would be for a different audience, one less likely to visit a blog, but perhaps a glimpse into How Shrinks Think? What do you think?

Play This For Your Children

I love this UTube video of a mom recounting her day to the William Tell Overture. I don't know who this lady is, but she's great. You'll forgive yet another of my diversions from psychiatry....




And yes, Roy, I posted a UTube video (not just a link) all by myself!

How to Raise Teenagers: I Must Have Slept Through That Lecture

Those of you who are regular readers may recall that in addition to being a psychiatrist, writer, and podcasting blogger, I am also the mother of two teenagers. It's okay, no surprises here, after all I went to medical school and I'm a psychiatrist which means I'm an expert in human behavior, those teenage years being just part of the developmental process. I know exactly what to do and say to assure that I have wonderful, happy, mentally healthy, well-adjusted, and successful children who glide through life glitch-free and openly share with me any of the little bumps they might encounter along the journey.

And now let me tell you about this little bridge I have for sale, it's a great bargain.

And let me tell you what they teach you about raising children in Medical School and Psychiatry Residency Training Programs. They don't teach you anything, at all, ever, about normal developmental adolescent behavior. Somewhere along the line I learned that babies develop a social smile between 5 and 8 weeks of age and they should be fed whole milk until age 2. Either the information stopped there, or I blocked everything else out.

Pediatrics rotations in medical school take place on an inpatient medical unit. I saw children with leukemia, babies with failure to thrive, kids with acute abdomens, and inevitably half of morning rounds went like this: "Bed A suffered burns on her right arm when mom's coffee spilled on her, Bed B has burns on his left leg from dad's spilled tea...." I did learn that parents should be very careful about hot beverages, hot bath water, and space heaters (--there was a major burn unit in the hospital where I studied). We had lectures on diarrhea while we sat around a table eating cookies. Not once did anyone tell me that it's completely normal for formerly articulate, intelligent boys to suddenly stop speaking and merely grunt for years at a time. Nor was there a course that mentioned how it's impossible for the mother of a teenage girl to dress right...or even breathe right. Honestly, I thought my own mother--who handled my obnoxious teenage years with grace-- embarrassed me because she was embarrassing. It didn't occur to me until I had teenagers of my own that it had more to do with me than with her.

Three months on an inpatient child psychiatry unit, with shifts in the pediatric ER, didn't help. I met kids who were completely out of control, chronic runaways, children who'd been violent in their group homes. In the ER I saw suicidal teenagers and had no where to place them --try finding an inpatient bed for an uninsured suicidal teen who's parent says they've had it won't take them back. Not only did I not learn a thing about normal adolescent development, but I saw the worst case scenarios of children who'd had lives that were tragically devastated at young ages, already paragons of loss, chaos, and upheaval. It wasn't a setting filled with hope; it takes a lot for a child to end up in an inpatient unit in an inner city teaching hospital.

Okay, so teenagers, this is the thing I'm figuring out: It's a stage, it's its own distinct thing, and being a psychiatrist, I have this tendency to look at my teenager's behaviors and extrapolate them to adulthood. I'm just getting it that a lot of normal teenage behavior looks surprisingly like impending disaster. Nothing about being a doctor helps with this, most of what I've learned being a psychiatrist makes it hard to keep things in perspective, especially when living with a teenage boy.

I'm not much for How-To-Raise-'Em books. Mostly, I thought we were doing fine by gut, but lately I've decided we could use a little help. I bought some books, I even read them, and I thought I'd share my thoughts about these books with you.

This was my favorite:
Get Out of My Life...but first could you drive me and Cheryl to the mall?
by Anthony E. Wolf, PhD.

This book was laugh-out-loud funny with descriptions that resonated so strongly I was left to ask how this guy knew my kid.

"What happens is that teenage boys develop terminal lethargy. They seem to catch a lengthy case of sleeping sickness. They appear to do nothing. If the normal speed of human activity is one hundred rpm's, teenage boys seem to go at around six."


You mean that's normal??? Why didn't anyone tell me? What a relief! And the list continued. I won't say I agreed with every thing Dr. Wolf says-- he sounds more willing to tolerate certain behaviors than I would ever be, but overall this was a quick read and did more for cuing me into Why I Shouldn't worry, What I Can't Control, and Why I need to Let Go, more than psychiatry ever has. Relief: yes. Sadly, I'm left knowing that my children are pushing me away because they are growing up and doing all the things they should be doing, and while it's always been easy to rejoice in their milestones, these stages entail a bit of quiet grief as I come to terms with the fact that my children will never have the relationship they had with me when they were little.

I Wanna Be Sedated, edited by Faith Conlon and Gail Hudson, is a collection of 30 essays by professional writers all on parenting teenagers. Okay, I admit it, I bought the book because the title was irresistible and at the moment I was surfing for books about raising teenagers, I really did want to be sedated. Some of these stories were hysterical-- we had both our kids read "How To Lie To Your Parents" by David Carkeet. "Mom? Everything's Okay, but..." by Linda Rue Quinn was funny even though neither of my children have actually set any part of our house on fire. The stories varied: funny, poignant, sad, even boring, but for the most part it was a compelling read. There were no parenting tips, it really was just the sharing of stories, and a reminder that teenagers, while in many ways alike in their stages, differ greatly in how easy or hard they can be to raise and what kind of people they actually are. The honesty of the writers was brutal at moments, at many points I was simply thankful not to share their problems, at other points I felt I'd found a kindred spirit. I smiled at Stephen J. Lyon's essay, "Commuting With Rose." He writes, "Anyway, as a parent of a teenager, you are always off balance--grasping at straws, parenting books, or a bottle of Zoloft. So you ten to stay with any small success. Sociologist love to rattle off statistics about how many minutes per day fathers spend with their children, always discounting the power of silent communication and the value of mere presence, along with the all-important fatherly stare and raised eyebrows. And they rarely speak of how little or erratically a teenager wants to relate with any parent."


Finally, I looked at Staying Connected to Your Teenager by Michael Riera, Ph.D. This is a more conventional How-To book and I had a harder time staying with it. In the first chapter, he suggests trying to talk to your teenager after midnight, and for a while, I'd try to stay awake that long. I made smores one night with my son and he recited to me the Shakespeare he'd had to memorize for school--it was definitely worth staying awake for and not a conversation that ever would have been had at a more civilized hour. Otherwise, though, it felt like the author had all the answers and I think my challenge has been to make peace with the fact that there probably are no real answers.

It's Fun Until Someone Gets Hurt, Then It's Hilarious

This isn't a post about psychiatry. Pretend you don't know I'm a shrink. This is a post by an old person ranting, most specifically by the mother of teenagers, ranting.

It's Fun Until Someone Gets Hurt, Then It's Hilarious

I saw that on a T-shirt recently, and actually the T-shirt was being worn by someone my age, the father of two teenagers. It pictured a skier stick figure, upside down, and I cringed-- why is it fun to watch someone get hurt? Why would someone make a T-shirt advertising that, and why would another someone buy it and wear it in public? I don't get it.



I grew up in a world where it became very important to be sensitive to others, to be conscious of what one says in terms of race, religion, nationality, gender. Words are important and if you utter the wrong ones, even innocently, you can be minced. I grew up in the North, post-Civil Rights, and attended integrated public schools and gender-balanced institutions of higher learning. Obscenities were bleeped on TV and Clarence Thomas was on trial for sexual harassment. My world started in a sensitive place, it's grown even more so.



Suddenly, it feels like the pendulum has swung the other direction-- a complete reaction to interpersonal sensitivity. I've entered (somewhat involuntarily, but hey, I had them) the world of teenagers. Words that have always been so powerful and negative, well, suddenly they're terms of endearment. I borrowed an iPod the other day to jog with-- Golly Gee, Wally-- 1800 downloaded songs and they each consisted of the same three obscene words chanted over and over. All I can figure is this culture irreverence-- perhaps best personified by the ugly and inept words of Don Imus-- is a cultural backlash to a world where being politically correct has become so important, so hammered into us.



I read an article not long ago in the Baltimore Sun-- it was about an entrepreneurial young man whose Internet T-shirt business had taken off. What an industrious young man. I went to the website, curious. Here's one of the shirts he sells:

You get the idea.

Mostly, the teenage world seems to have some feel for when and where-- they utter the unthinkable words and phrases amongst themselves, they understand (or so I'm told) their own code-- they keep this world hidden, and well they should. I may be wrong, but the rules all seem fuzzy as to who can say what to whom, where and when. Probably, and I may just be old, Mr. Brady, it would be fine if T shirts didn't announce the insensitivity of the wearer.

The good news is that I found some Led Zeppelin tunes on the iPod. There's still hope.

Dr. Crippen, Blog Fodder

Oh he's done it now. He has truly done it. I have spent several years of my life working to become a doctor, only to have Dr. Crippen suggest that perhaps I and other women physicians don't have a right to certain specialties or job flexibility. He quotes a Dr. Sarah Blayney, who writes:

"The training jobs as they stand are all or nothing. You either do all the hours or don't get the post. I want to pursue a career in hospital medicine, which will mean me committing to a minimum of five years of fairly hefty on-calls. "

At the moment I am 24, single and am enjoying life. But in four or five years time my situation may have changed and I may not want to work those hours."

She said flexible working would be particularly relevant to female colleagues wanting to start a family, but said male colleagues were also interested in changing their hours. For example, some wanted to take time out to travel, she added."

Note that the need for flexible job hours is cited as a concern for both men and women. However, Dr. Crippen takes it upon himself to limit this issue to women:

"It is right and proper that women can pursue a career in medicine. But at what stage do we decide that the needs of medical training can no longer be subsumed by the needs of working mothers?"

Perhaps Dr. Crippen would do well to remember that not all women are, or are planning to be, mothers. Perhaps he would do well to remember that here are many other reasons for limiting on-call and extended working hours---like retaining one's sanity. But that's OK because he also suggests that: "Sarah lives in cloud-cuckoo land. She wants the job but she is not prepared to do the hours....You need to grow up a little.... Just because you are a girlie, you can’t expect medical training to be turned on its head."

Good God. I thought we had grown beyond that. I thought I had left thinking like that behind on my surgery rotation, along with the bra-snapping resident and the resident who once complained about me scrubbing in: "I found a medical student to help, but she's a girl." Given that over half of all medical students in training today are female, it's truly time for this discrimination to be over.

So please feel free to visit NHS Blog Doctor today and leave a comment. The only comment I have to say right now is: "Sic 'em!"


[From Clink: Sigh...she insists on modifying my post again...At least I can modify her awful color choice.]
Guess What? The first half of Chapter 10 is up on Double Billing.

Someone Knows the Trouble I've Seen

First: Podcast #23 is up. It's getting great reviews.
Second: The rest of Chapter 8 is up at Double Billing.
And now for our regularly scheduled post:

I don't know Michelle Slatalla. I've never met her, never talked to her, haven't poked her. I imagine she wears her pants too high, but I don't know if she drives a cool car, if she sends text messages to her friends, what shows she watches or wines she drinks. What I do know is that she does a good job of talking about MY life (..maybe she reads Shrink Rap?)

In Thursday's New York Times, in "Cyberfamilias: omg my mom joined facebook!" Ms. Slatalla writes :

I HAVE reached a curious point in life. Although I feel like the same
precocious know-it-all cynic I always was, I suddenly am surrounded by younger precocious know-it-all cynics whose main purpose appears to be to remind me that I’ve lost my edge.


Many of these people are teenagers.

Some of them I gave birth to.

Wait, did I write that? I don't remember writing that. Does this person own the same children I that I do?

My newest comrade in parenting teenagers then goes on to recount how she joined Facebook and repeatedly poked (?harassed) her daughter and her daughter's friends, asking them to be her friends. Her daughter's friends allowed her in-- she now knows who is going where and with whom. Her daughter resisted, but Ms. Slatalla, bless her heart, poked the child into at least partial submission, and the daughter finally befriended her, but with only limited access to her profile-- help me if I get the terms wrong here, I'm decades too old for this world.

Okay, so I have a facebook page. And I poked one of my kids. He said no. He came downstairs in real life and told me not to poke his friends. I would never poke my kid's friends, even I'm not that dumb (sorry, Michelle). I've left it, I poked only once. I'd previously been blocked from his Instant Messenger and I've decided to leave it that I'm happy he doesn't Call Screen me out, but that may be because I pay for his phone. It seems I can E-mail too.

So Michelle Slatella set up her Facebook profile last week, according to her article. I set mine up 6 months ago. This is the photo I've put on my profile:
So six months and I have ONE friend. My niece let me in. I barely know her, she's a college student, and her profile requests that you post memories you have of times you've had together with her. I started to write on her wall, describing how beautiful she was as a baby, how I loved dancing with her in my arms when she was 7 months old. She really was a total doll. Then I decided that no college student wants their aunt on their Facebook wall dancing with them in infancy, so I sent it to her privately. I haven't heard from her since and I've had to content myself with looking at her photos and reading the birthday greetings on her wall.

I had another friend for a while. Rich poked me. I accepted (I've always liked Rich) and I checked off that I knew him because we hooked up. I've never hooked up with anyone, I was married before hooking up was invented. But patients talk about hooking up all the time and here was my cyber-opportunity to pretend I was cool. Now I'm also friends with Rich's wife, and maybe this explains why he's no longer listed as my friend? Apparently, I've been unfriended. Wow.

Patients talk about Facebook. And the truth is, they're all under 30. No one my age talks about Facebook. Then again, no one I've seen over 30 talks about their blogs either. It's a whole other world, with all its own lines of significance and innuendos. Who pokes who, who doesn't poke who, who lets you in, and who unfriends you. I grew up in a world where people slighted you by not returning phone calls and and not saying "Hi" in the hallway.

Okay, enough, I'm going now to poke Michelle Slatalla. I think she's my age. I wonder if she has a blog and a podcast. If she wants to be my friend, I'll write on her wall.

Because It Feels Good

See other Savage Chicken cartoons here

The Psychology Of Altruism

I saw a story in our local newspaper recently that summarized the results of a Johns Hopkins survey of people who volunteer for research projects. The projects they were looking at were Phase I clinical drug trials, in other words studies that are done using drugs on humans (as opposed to animal) subjects for the first time.

It led to the obvious question: Who the heck would do something like that?

Now, I knew a couple people who volunteered for studies when I was an intern. They were both rather adventurous, young, and somewhat in need of money. Looking back on it I could say that they were trusting people who believed that the researchers wouldn't do anything to seriously put them in harm's way and that they were also fully armed with the youthful denial of any possibility of death, disability or adverse consequences to many things they did.

Some of the subjects in the survey reported that they essentially became professional guinea pigs, even travelling from state to state to make a relatively lucrative living (lying to the investigator in the meantime about their extracurricular research activities). However, about half the volunteers were employed at the institutions where the research was being done. They reported that volunteering made them feel good that they were helping people.

That got me thinking about altruism in general. We have many examples of altruists in our society: parents, volunteer firefighters, soldiers, people who sign organ donor cards or send money to charitable organizations. What leads people to give up something when there is no immediate benefit to the giver? Or worse yet, when there are always people ready to take the benefit without ever making a sacrifice in return?

There are religious motivations for altruism, but this being a psychiatry blog I thought it would be more relevant to look at the psychology and evolutionary biology of altruistic behavior. (Don't worry, I'll keep it short to avoid being snooze-worthy.)

In The Ego And The Mechanisms Of Defense Anna Freud described the concept of "atruistic surrender". I'm admittedly nowhere near being an analyst, so if any reader out there has a better handle on this than I do feel free to enlighten me. As best as I can figure it out, altruistic surrender takes place when a patient's unconscious conflicts are triggered by superego suppression of impulses. To manage the resultant anxiety the patient projects the forbidden impulse onto someone else, identifies with that person, then works to help that person satisfy the impulse. For example: someone feels the urge to eat lots of gourmet food but this impulse triggers an unconscious conflict. The impulse is attributed externally: "I am not hungry. They are hungry," and the person throws herself into feeding the hungry or cooking extravagant meals for friends and family.

Whew. This must be why analytic training takes years.

The evolutionary perspective is much more simple-minded (lucky for me). A behavior survives for one of a few reasons: it's good for your relatives, it helps you have more kids or it improves your standing in the community. The weird thing about altruism is that it doesn't seem to do any of those things, yet you see the behavior in non-human species as well as insects. And if altruism didn't do something to enhance survival then all altruists would be extinct by now. What gives?

This is where I get to refer to an economist---probably the only time we've mentioned economists on the blog even though the few I've known have been pretty terrific people. Robert Aumann and Thomas Schelling developed game theory in order to understand economic cooperation and conflict, but they ended up enlightening human behavior. They used mathematical models to prove that given enough time and enough opportunities for strangers to interact the altruists come out ahead economically the majority of the time. Later researchers showed that the "cheaters" (people who don't sacrifice) eventually get punished by the group by being denied opportunities to interact---no one wants to do business with them.

And finally, now that we have this gee-whiz cool fMRI technique you can pretty much count on the fact that someone somewhere has taken a picture of an altruistic brain in action. One study showed that increased activity in the posterior superior temporal sulcus strongly predicted a person's likelihood for altruistic behavior. (And now that I've volunteered my time to write this summary I can practically feel my posterior superior temporal sulcus glowing.)

So now when someone asks you why you volunteered for that activity that everyone else in the neighborhood is hiding in the attic to avoid, you can say: "Because given X number of trials involving Y individuals there's approximately Z percentage likelihood that I'll come out ahead by doing it." Or you can keep it simple: because it feels good.

To My Son...

My gansta-wannabe child has left home to try his brain at a college course this summer. Never a camper, this is the longest he's been away from home.

So far, life without you:
I've been thinking about you and wonder how you are. I liked talking to you last night, but a little more info would be okay. Say Hi to your roommate, John, from the unknown place. I hope he likes watching The World Cup and you find someone up there who isn't a Geek. I'm glad they found your luggage and you got to bring your clothes with you. I hope you wear it. If you send me your email address, I'll write to you.

Even your sister misses you. Dad tried to give her your seat at the dinner table (why? ask Dad...he thought she was too far away at the end of the table) but she wasn't interested.
Love,
Mom

I should have something more interesting--from a psychiatric perspective-- to say about my oldest child growing up, but it's too hard to think about the fact that soon he will be leaving for good.

Roy: Students' blogging may get them suspended

The Libertyville-Vernon Hills Area High School District 128 board has voted to suspend students for "maintaining or being identified on a blog site (that) depicts illegal or inappropriate behavior."

Is this for real? I don't see how this can be enforced, and it is easy to see how it can be abused. I am publishing this blog under the name "Roy". Say I called myself Roy Johnson. I could get the real Roy J. in a lot of trouble with the school.

Do you think the real Roy Johnson would sign a blog or a comment under his real name? It seems to me that most blogs are de-identified in this manner. And who defines what is "inappropriate"?

Kids have enough to worry about without having to worry about getting suspended for a blog. How about some education or counseling about online risks? This isn't easy, I know. I called the parent of my child's friend to warn him that his daughter has her cell phone number readily available on another friend's MySpace page. He treated me like I was the Volunteer Fire Department calling at dinner time on a Friday night. I even emailed him the link. The number is still there.

Maybe I should have emailed her school principal. Got her suspended. That would teach her not to blog inappropriately. Of course, what would she do at home while suspended? IM and blog with all the other homebound blogging convicts.

At least the NSA isn't going after them. Yet.

Bah Humbug Snack Parent

There's not a way of talking about this without sounding like either a self-righteous (probably vegetarian) health food proponent, or a child hater. I'm trying to decide which is worse.

If you've ever had a child who has played a sport, you know what "snack parent" is. If not, this is how it works. You're sitting quietly at the first game, minding your own business, hoping your kid isn't the kid who causes the gut-wrenching loss, when suddenly someone passes you a sign-up sheet: Snack Parent. The dates of play are listed and you are told it will be your responsibility to bring all the little players their after-game snacks. You think about your schedule and choose a date you know you will be available. The call-to-duty is a heavy one; missing a child's game (or God-forbid having your child miss a game because YOU have other obligations--simply unheard of) is bad enough, but missing a game where you are the Snack Parent would be unthinkable.

My family eats dinner together, sitting at the table with cloth napkins. This supposedly prevents future psychopathology, at least in the children. We sit down together at what should be a civilized meal and everyone grabs the food in a rapid free-for-all. The point being, I don't want my kids eating snacks right before we sit down to dinner. And if I did, I'd want some control over the snacks; soda and chips just don't feel like wholesome appetizers.

Okay, so yesterday I was Snack Parent. I'd like to bring carrots, but I visualize my children lying on the analyst's couch saying "Everyone else's mom brought Reese's Cups, My mother brought carrots." The cost alone is enough to drive me to the bakery, and the Guilt-- let's not even go there. Neither, however, compare to the punishment that would be meted out by the carrot-bearing child who will never again be able to show his face.

Back to yesterday. First, I'd never signed up (hmmm, must have overlooked the sheet that day) and I'd gotten an e-mail from the coach pointing out that our family was one of only three families shirking Snack Parent responsibilities. I thought I already did Snack Parent, in fact I did it on my kid's birthday and actually brought cupcakes. Oops, right kid, wrong team. I emailed back a Snack Parent-acceptable date and received email confirmation. Okay, our family springtime activity calendar looks like the military plan for invasion of an enemy nation. I knew there would be no time to Get The Snacks, and so, staring at the diagrams of who-goes-where, I ran out days in advance to Target. I lingered in front of the individual packages of bear-shaped graham crackers in 100-calorie packs. This couldn't be too bad. They come in 12 packs, there are 13 girls on the team. I took two and headed to the drink aisle. As fate would have it, on my way I passed an Orthodox Jewish couple which reminded me that two of the girls on the team are Orthodox Jews. Are bear-shaped graham crackers Kosher? I stared at the package, turned it over and upside down, and could find nothing that would indicate they were Kosher. Back to the snack aisle where I settled on Cheez-Its shaped like SpongeBob Square Pants, 160 calories/package. I surrendered and bought them. The juice aisle yielded similar problems, and I purchased little bottles of water. This, I was sure, would work, and maybe she'll get by on twice-a-week psychotherapy. The schedule failed, my other child's game was canceled, requiring that I somehow be in two places at once, and a neighbor had to pinch-hit because I was Snack Parent. So, the story ends and the Blog Post begins when another family also showed up with snacks: a large assortment of candy bars and cans of Dr. Pepper. The bottled water and SpongeBob Cheez-its were left untouched. I'm just hoping we can find a psychoanalyst with side-by-side Mother/Child couches and two-for-the-price-of-one coupons.