Stuck in My Craw

One of the things I was taught in medical school: common things are common. 

These things have been more common lately. I know I’m starting the grumpy old man phase of my blogging life, but good grief, people. Really?!?

Disrespect: 

No direct eye contact. No acknowledgement, verbal or otherwise, when greeted with a cheery good morning. Annoying behaviors designed, quite consciously, to actively annoy and derail the time in the office. Texting, typing, talking and playing games on phones in the office when active input would be appreciated! Ignoring questions outright or refusing to answer. 

Sullen mood: 

No, I’m not talking about serious depression or active psychosis. I’m talking about deliberately hostile, staring, scowling, defiant presentations designed to minimize communication. Really?

Lack of responsibility: 

“I don’t know why I had to come here.”

“I’m not sure how that gun/knife/weapon got in my gym bag, but it’s the kid’s fault that found it and turned me in that I got in trouble.”

“My teachers suck. They don’t know how to teach. They’re stupid.”

“Because I don’t like to do chores, that’s why.”

“I just don’t do the work. I don’t feel like it. No, I never turn my homework in.” 

“They can’t do this! They can’t take away my iPhone/iPad/Gameboy/PlayStation/XBox/flat screen TV just because I have four Fs and a D!”

Blaming:

It’s the teacher’s/principal’s/parents’/other kids’/government’s/doctor’s fault.

Anger for anger’s sake.

Refusal to problem solve or to see anything positive at all in a situation. 

Adversarial stance (kids and parents both!)

“Fix me!”

“We’ve tried everything and nothing works for him.”

“Nothing you can do will help.”
This was a week, friends. 

This is not entirely a mental health crisis. 

This is a crisis of investment in parenting, house rules, expectations, empowerment, upbringing, respect for elders, and establishment of normalcy in childhood. 

Enjoy your weekend. 

Next week, we all have more work to do. 

For Example…

My youngest child will graduate from college in December.

College.

My youngest child, who by definition is no longer a child.

She is taking her certification exams today and tomorrow to teach in South Carolina, her home state.

My oldest child, my namesake, is a mother of three. She sings. She dances. She acts. She throws Frozen-themed birthday parties like nobody’s business.

My middle child lives in Denver. She is passionate about all the right things. She is tender hearted, but she has learned to be bolder and stronger and to make her opinions known at both the local coffee shop and the Colorado ballot box.

At times like these, at times of great achievement and wonderful milestones, I am transiently consumed with anxiety about whether or not I have been a good parent. Have I been a good example for my children? Have I just talked the talk or have I walked the walk?

When your children are very young, they look up to you physically, mentally, and emotionally. You’re taller, stronger, smarter, and certainly more emotionally stable. They carry this grand delusion forward for years, and you bask in the parental warmth and glow of knowing that you need never lose a chess game or foot race or impromptu swim meet. They know they can’t beat you, you know they can’t beat you, so you let them beat you. Sometimes.

As time goes on, they begin to discover that your loafers are dusted with clay. Your arguments have holes in them. Your faith is not as rock solid as you once told them it was. Santa becomes real to them in that he is not.

They grow, and isn’t that what we dream about and pray for? They grow tall and strong and witty and funny and emotional and beautiful and intelligent and creative and passionate.

They become, at the same exact moment it seems, us and not us in the twinkling of an eye.

Do they see my struggle? Do they feel my ambivalence? Do they sense my intellectual gamesmanship with myself? Oh, I can try to keep these things, these changes of my own, to myself, but I know better. Just as our children may have thought we had eyes in the back of our head, they have always had tiny invisible emotional divining rods coming straight out of their smooth, wrinkle-free foreheads. With ancillary bullshit detectors hanging like earrings off their ears.

We parents have never seen them, but we know they are there.

Have I been a perfect example for my children? Heavens, I gave up on that decades ago. Have I been a good example of a work in progress? I hope so.

I have wrestled , am still wrestling, with the meaning of it all, globally. My values have not changed greatly in my fifty seven years, but my adherence to them has been tenuous at times. Faith has been the most powerful force driving me rapturously from within, and other times has been the most oppressive fetter binding me tightly with indecision and fear.

My internal world has not always mirrored my external world. Some of you know this intimately. Others have never had a clue.

So, have I been a good example for my children? Only they can answer that.

The quest goes on, though. I have three grandchildren and hope to one day have more. I want to be a good man to these precious little folk who light up and call me Papa whenever I come through the front door to visit.

I am not a perfect man and know that I never will be.

Life is not a stenciled, cut and pasted, color matched exercise.

It’s messy, it’s sometimes painful, and it’s always full of surprises.

The best example I can hope to provide, I think, is to more clearly show others how I move through the morass. How I try to make sense of it all, while making the world a little better than it was before I got here.

My children are healthy, happy, productive women who are already making their marks on the world and the next generation. They are moving away, and yet they will always be with me, and I with them.

Isn’t that what being a successful parent is all about?

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Childless

ImageApril 20, 1965.

A day like any other day, I suppose, but not for my parents. 

I was seven years old, and I remember nothing of it. Nothing at all. 

Isn’t that odd? An event that could change the dynamics of my entire family forever would not even be a part of my conscious mind as I moved forward in time every April 20th after that? Odd, but true. I don’t know exactly how it happened, how it affected my folks, how they processed it, who was there with them and for them. 

She didn’t even have a name. Infant daughter of…was all the simple gravestone says. She rests in the bright middle Georgia sunshine at my father’s feet, no doubt where she would have spent many happy hours if he’d lived longer. If she’d lived at all.

I often wonder what she would have been like. Dainty and feminine? Rough and tumble? Smart and searching? Ready to change the world? Loving, caring, feeling, giving? The apple of her older sibling’s eye, I’m sure of that. Someone to be protected by a bragging, proud brother, I’m sure. Someone to be a protector too, somehow, for a brother who even now needs a buffer between him and the big, wide, harsh world some days when it gets to be just a little too much. 

I might have done that for her. She might have done that for me. 

How sad for a gravestone to have but one date inscribed on it. One date. Birth and death all at once. No dash. 

 

Oh, I don’t know. Thank you for asking. 

Maybe because we just passed through another Memorial Day with its row upon row of white crosses and the thousands of kids that lie there, motherless in the ground. 

Maybe because of what my grandmother said to me, in her grief, as she waited, slumped over in the parlor before my father’s funeral. “It’s not right. No parent should have to outlive their own child.” 

Maybe it’s because one of my friends has been dealing with a very sick child. “She’s never been this sick.” The quietly frantic pleading and praying and busyness that goes with that, with the knowledge that you will do anything, everything in your power to make sure that child gets well and lives. There is no higher calling for a parent than to be totally focused on the need of their offspring, until whatever is assaulting them is totally annihilated. 

Maybe it’s because she came to see me the other day, wrapped in grief so raw, so tangible, so real that you could see it in the bathrobe, pajamas and house slippers she wore to my office. It didn’t matter one whit to her what she wore that day. I didn’t matter that her red, tear-stained face hadn’t seen eye shadow or rouge or powder in days, maybe weeks. None of that mattered.

She shared her grief with me. She shared what it must have been like for my own mother on April 20, 1965, and every April 20th after that-every day after that. In her brokenness, she still got out of her house, trudged the distance to my office, and tried to help me understand what she was going through. 

Like so many patient encounters, this one was good for both patient and doctor. This one showed me how very real the connection between us is, the tiny thread of communication that persists even through the darkest hours, the most blinding pain, the most raw, aching, devastating grief. I felt it, but I could not put it into words. 

I didn’t have to.

Sometimes it’s best for the doctor just to be present and say nothing. She did it for both of us. I just sat there with her, feeling it, letting her feel it, knowing that eventually, it will get better. It will never go away, no never, never, never, but it will get better. She was not convinced. 

She looked up at me and made direct eye contact once in that session, only once, and summarized her grief.

“There is no pain, I mean no pain in this world, that is worse than this pain.”

At that moment, I believed her. 

 

Suffer the Little Children

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It is hard to see a child in pain.

I have seen quite a few children in the emergency departments of South Carolina in the past three years, more than I could have imagined just a while ago.

Now, in the interest of full disclosure, I am not a child psychiatrist by trade. Like any general psychiatrist, my training at the Medical College of Georgia Department of Psychiatry and Health Behavior, now at Georgia Regents University, provided me with didactic and clinical training in a variety of sub-specialties in my field, including affective disorders, substance abuse, and the disorders that children may suffer from. Most hospitals that I work in now, desperate for help with children who come in sick and in need of assistance, grant me and others like me privileges to evaluate these kids, simply because they do not have any other choice. There are very few trained child psychiatrists in the United States per capita, and they can pretty much command their price and practice where and how they wish.

That being said, I have been scrambling in the past three and a half years to find my sea legs and get into the rhythm of seeing children and their families in emergency departments and in the clinics of my own home mental health center. It is a different rhythm all together, rewarding when done right but extremely taxing and challenging and physically and emotionally exhausting at times.

In the ED, children come in for various reasons including depression and anxiety, acting out in school, danger to themselves (yes, I have seen children as young as four years old who were actively suicidal and had a specific potentially lethal plan to kill themselves), and for the aftermath of sexual or physical abuse or the effects of other trauma that they have lived through. Witness the recent graphic pictures of children being pulled from the rubble of a school monstrously devastated by a killer 200 mph tornado.

Before I go any further, let me make one thing abundantly clear. Children are resilient. Wonderfully and fearfully resilient. I think this is why we still exist as a species today.

One of the things that bothers me tremendously about seeing kids in the EDs and clinics today is the fact that parents have lost their way. Yes, I am now turning this post about children on its head and speaking about their parents. Indulge me, please.

Parents bring their children in for evaluation, sometimes as young as two years old-two years old, mind you!- because the nursery school can’t handle their outbursts towards other toddlers. Elementary schools tell parents that their child will not be admitted back into the classroom “until you see a psychiatrist and get him put on some medication to control him”. Some children are refusing to get out of bed in the morning, refusing to get dressed and go to school, causing their parents great anxiety because “I just can’t make him do anything”. Some parents are resorting to the old taking away of privileges tactic, retrieving in-bedroom game consoles, televisions, computers, and even smartphones.

Wait. Stop. Hold on.

These parents tell me that their children are out of control, that they need to be medicated, that they “are ADHD and bipolar”, that they are SICK, when actually they are suffering from one thing and one thing only.

A profound lack of discipline in the home and at school.

Parents do not feel that they make the rules any more. There can be no house rules. There can be no punishments, behavioral or corporal or otherwise, because Little Johnny has the Department of Social Services on speed dial on his $600 iPhone and will call them if his parents lift a finger to keep order in their own home.

Teachers are hamstrung, overwhelmed by sheer numbers of children in their classrooms and piles of lesson plans and paperwork designed to leave no child behind, all the while leaving good teachers behind who can no longer stomach the profession they once loved.

My friends, I see a lot of kids in the EDs of South Carolina these days. Granted, some of them need real psychiatric help. Some of them are severely depressed. Some of them have been sexually and physically and emotionally traumatized beyond your wildest imaginings. Some of them truly hear voices and see dead people. I see these kids and I evaluate them and I recommend the treatments they need.

Others are victims, yes, I said victims, of a system that has lost its way. A system that no longer lets parents be parents and set the rules in their household that lead to a healthy, happy functional family. A system that has taken away control of the classroom from the teachers and placed it in the hands of bureaucratic suits who have never had chalk dust on their hands, much less come up with creative ways to engage a classroom of seven year olds for a day. A system that tells us that little children are ill, sick, infested with the seeds of diseases and syndromes like Intermittent Explosive Disorder, when in fact, they are having tantrums and need to be disciplined by strong parents who love them.

I am appalled dear readers, absolutely appalled, that in this age of technology and enlightenment we are too stupid, too afraid or too threatened to call normal behavior by its rightful name and deal with it. I am appalled that we are trying to turn normal, sometimes troubled children who have briefly lost their way into psychiatric patients with diagnoses that will follow them for the rest of their lives.

I fear for our own sanity and wellbeing, and that of our children and grandchildren, if we do not start to , as Vernon Howard said, “Learn to see things as they really are, not as we imagine they are”.