How to respond to a young person in you care once they return from rehab or a clinic.  The precarious balance between caring and confronting.

Alice

 All parents of growing children have to find a balance between discipline and freedom. These are value-based decisions, and a familiar source of conflict between parents. You do want your children to be able to take care of themselves once they grow up, yet you also want them to feel cared for and free when they are at home. When are you being too harsh, and when are you overindulgent?

An adolescent or a young adult comes home from a rehabilitation centre or a psychiatric clinic, and this question moves to the foreground. It can become a daily – if not an hourly- dilemma.

Must I wake him up if he sleeps late? Can I insist that he does the cooking, or is that asking too much?

At the end of this section there are guidelines for all parents who find themselves in the quagmire of dependency versus independence.

This blog is in the form of a letter to the parent of a 17-year old.

My next blog will contain the letter to the 17-year old.

The letters are about the essentials, which in themselves are quite a lot.

Every single aspect that I write about matters.

Do try to trust me on this one, I write from experience.

Dear Robin

My heart goes out to you as I write this letter. One of the many things that I have learnt over the years is that, when a child breaks, there is at least one parent breaking too. It can happen suddenly, like a glass falling out of your hand, but more usually the suspense has built up over time, with dread having settled in your heart. Inevitably, one day something essential breaks, and the walls come crushing down.

When I first saw Samantha, she had minimal contact with reality. She had been hanging onto a fragile thread for far too long, and it broke at last. In some ways, this was a relief. You had been hoping for a small miracle – a nice boyfriend, something of interest out there that would focus her attention, maybe a different school or just a teenage phase that would pass. And then we were sitting in my room, facing this reality: My child is too badly broken to be fixed by a ‘normal’ intervention. You were on the route that you have been terrified of all this time: Seeing psychiatrists and placing your child in a clinic. Your child being diagnosed with a mental disorder. You face the shame, and the fear, and the guilt.

But here we are, and Samantha, for now, is out of danger. Yet, as you understand so well, out of the clinic does not mean out of danger. The decisions that the two of you take over the next two years are the crucial ones. You get that, and it wakes you up at night: What if you do the wrong thing? Should you have reacted like you did today?

I have written down some home truths – signposts along the tricky path.

  1. By now you probably suffer from burn out. A parent who has been stressed for a lengthy period of time, has depleted resources. Please, please take care of yourself. Physically. Do not let yourself go. It will make you feel worse, I promise. Spend your precious money on your hair, your face, new clothes, a hobby, a course, whatever makes you, singularly, feel that life is worth living and that you are more than your child’s problems.
  2. It is also your fault. Accept that. But it is not only your fault. Accept that too. The part that you can change is the part that was your fault. Do not, whatever happens, repeat that! Overindulgent? Overcritical? Avoidant? Depressed, alienated, aggressive or addicted yourself? And what about your marriage? The atmosphere at home? Somewhere there is an area of your life that is in need of a makeover. Ask your child, s/he will tell you. If you want your child to change, demonstrate that change yourself. So many parents want their child to change; yet do not understand how very difficult this can be for the child, because the parents keep on doing exactly the same. It will also help you to understand how difficult change is.
  1. You can’t do this alone. Talk about it. The more you talk about it, the less ashamed you will feel. Ask your closest friends for their honest opinions and advice. Tell your boss. Ask for help from friends and family. Insist that her father helps you. This is good for her too. Acknowledge that you need help, also to Samantha.
  2. You do have to decide what are the minimum requirements that will enable Samantha to move forward.. Decide on these together with her therapist, the family therapist, the psychiatrist, Samantha’s sister and her father. It is important that we all agree to stick to these conditions. I have learnt over the years that when you face a real battle, you need to deploy a squad.

Minimum conditions that we have already agreed on:

  • Samantha will stay with her father and stepmother every weekend from Saturday afternoon–Sunday afternoon. This is as much for you as for her. For you, so that you can regain some strength, and for her, so that she does not become overly dependent on you again.
  • Samantha will receive pocket money: enough so that she can pay for her own transport, toiletries, phone time and one fashion magazine per month, but not so much that she will be tempted to stay at home forever! She has to be somewhat uncomfortable without being overstressed. Neither you, nor any other family member will provide her with any additional money.
  • Samantha will get up by 10.00 every morning. This means that yes, you wake her up cheerfully, open the curtains, and open the door when it is time. Do insist that she gets up. She has agreed to this and it is in her best interest.
  • She is allowed a maximum of 120 minutes on the Internet or television every day. No more. Please adhere to this limit yourself.

If you want Samantha to improve you have to adhere to these fundamentals. There are no exceptions. It is not for ever, it is for six months, thereafter we will reconvene.

Occasionally you may “lose it” That is fine, and it may even be helpful. An occasional melt down is allowed! It is a natural outlet when under severe stress. Definition of occasional: No more than once a month. If you find yourself at the end of your limit more often, talk to a friend and/or get help.

  1. Do not overindulge Samantha’s problem. By this I mean do not focus on her problem and her moods to the exclusion of the rest of her personality. When you can see that she is in great distress, you can hold her and say reassuringly, “I am sorry, “I know you that you are having a rough time, but we will pull through. You have come a long way, and together we will make it.”

Practice listening up to a maximum of 20 minutes, and with the exception of her sharing some new personal information with you, after 20 minutes change the topic gently but firmly. The general guideline is 5-10 minutes of sympathetic listening – do not skip this part- followed by practical rebalancing.

Not speaking about plays an important role in keeping people unbalanced. Some families talk too much about the problem, others too little. You have to take your own measure and create a balance. Both are important: being able to speak about – and be listened to – and being able to not always speak about, and to focus on something else.

We know that a psychological problem is also maintained by a) an overemphasis on the problem b) an overemphasis on “me” and c) an overemphasis on emotions.

And that activities that have nothing to do with a problem are important, as they help us to focus on something outside of ourselves, and gives us something else to talk about. (It can become habitual, and really tedious and unhelpful to talk about personal problems all the time.)

Remember what I said about changing your own habits! Samantha will try out all the habitual responses that the two of you have built up over the years. “But mom, I am too sad to go out today.” Do not fall for old habits my dear!   You don’t have to be harsh, just firm and not indulgent. “I know, but Auntie Sue is expecting you. Go and enjoy, give her my regards.”

Whatever it is that she does, make sure that it gets her out of the house, and gives you a small break.

Do not fretfully enquire on return if she was ok. You have to pretend normal! Ask about auntie Sue.

  1. Loss of reality: If you see that Samantha is losing her footing, and drifting into unreality, interrupt her immediately. In the beginning you will have to be hyper vigilant. In time it will become less. Ask her an ordinary question (“Do you know where my keys are?”) and redirect her towards something ordinary, “ Won’t you please get dog food when you go the shop? I have been wondering if this dog food is causing her to scratch. Maybe we should try something different?” In other words, get her mind engaged with something that is concrete. And firmly based in the world of real.
  2. Stop any ‘weird’ behaviour in its tracks. It is alike to stopping a puppy from chewing your computer chord. She wants to paint her room black? The answer is “No”. Why? “ Because that is what unstable people do. Once you are stable, you can paint your room any colour you like.” She wants to paste strange writings on her wall. “No.” Why not? “Because we do not want the voices in your head to become real. You may think that they are helping you, but actually they keep you trapped, so no, we need to change them to normal. Then, you will see, you will have no desire to write them on your walls where they scare the wits out of me and keep you trapped in despair. So hey, out they go.” (A light humorous touch is always useful). She is drawing strange bloody claws?   “Samantha if you want to draw bloody claws, please do that with Elzan (therapist). In this house, please draw normal stuff. Draw the lounge, or the cat. Or your favourite positive fantasy or dream. In here, we have to do stuff that builds hope and life.”

One of the scariest things that has happened when people lose contact with reality, it that destructive autonomous forces seem to have taken control of their minds. The role of medicine is to keep the hallucinations under control. Our role is to bring her back to reality. To keep her grounded. We have to do this gently, but firmly.  Remember that the voices in her head are dark and seductive. Kindness and love is what she needs now. But also firm boundaries and small concrete daily responsibilities. What will a competent and resilient 17-year old be able to do? That is our end goal. We must be sure that the steps that she is taking every day will be towards that other safer shore.

  1. Have good times together. The more physical and sensorial, the better. Experiment with making your own pasta at home. repaint a room, watch an old-fashioned movie and cry, sort out the garage, take moderately difficult hikes, attend dance classes, music concerts.
  2. One of the reasons what happened, happened, is because something that should have been addressed long ago, has been suppressed for too long. It is the role of the therapist to take care of Samantha’s. Your role is to take care of your own. In my experience this is often something that has been passed on from your parents (who may have got it from their parents. It is the “sins” of the fathers and mothers, being passed on to their children). This may sound corny, but an adolescent in serious trouble, often helps us to see what are the bad habits or secrets that has been passed on from generation to generation. It can also show us what has been in desperate need of change in a marriage.

Three findings to keep in mind for a healthy balance between discipline and freedom

It is useful to remember that longitudinal research findings from all over the world have shown that people who are resilient and who can cope with adversity, have three characteristics in common:

A. A Sense of Belonging

The ability to be connected – to have meaningful relationships and to feel that you belong to a wider community, to feel that you are rooted in a community of which you are a valued member.

With this in mind, it becomes clear that rehabilitation must also include a reality check that addresses this. Often we have to begin by repairing family relationships.

Does your child feel that she is at home in the immediate family? If not, you will have to get help to repair relationships within the family. Family is our first port of call for a rooted sense of “home. It goes without saying that a house is not a home. So if you and s/he has to do a rethink about this, then this is where you begin.

If your house is already a home, then you cast your net wider. What person/ activity /group can your child join out there where s/he would be able to feel that s/he belongs?

Footnote: this obviously goes for you too!

Alienation is at the root of many a psychological problem.

A note on younger children: This is a strong need in young children. They love belonging to a wider family and a small community. This is not a time to be harsh on family members: children love having grandparents and cousins and regular people coming to visit.

 B. Self Determination

Self-determination. This one can be tricky. It is the most common excuse used. “You can’t tell me when to get up”. “Stop telling me what to do.” Is that not self-determination? No, that is subterfuge. It is a way of staying within the problem. Just as you have to change, your child has to, too.

It is clear that the choices that your child has made, has led her/him into trouble. So, you start out small. On what days would they prefer to prepare dinner/walk the dog? What classes would they like to take at the gym? In other words, the ground rules are set, but within the ground rules, they have choices, which will be respected.

Week by week, month by month, you have to make sure that healthy decisions are increasingly made by them, not by you. Some hiccups will occur along the way. Make sure that you address them immediately.

Love them a little bit more for every healthy decision made.

I wrote about self-determination and children, and more extensively on adults, in previous blogs on Emotion Regulation and Will.

 C. Creating and finding Meaning

Let me state this in its opposite: What is not meaningful?

In general: Watching television, playing games on your phone, eating when you are not hungry, cleaning house… anything that is used as a distraction.

Specific to you: Anything that does not make you feel satisfied on completion. Tidying your room can be a form of distraction or a meaningful activity: It depends on how you feel once you have completed the task.

Whatever gives one a deep inner feeling of satisfaction is meaningful.

We can look back on our lives, and pick out the times when we felt truly alive and connected. We can be honest about our inner yearnings, and resuscitate them. Ignoring inner longings is cause to many distractions, and believe me, a significant part of the original problem. So give your longings their due. And no, it will not be easy (bad habits have strong incentives), and it need not be a big enterprise, but at least you won’t be wasting so much of your life anymore.

Explore wider forms of meaning. Religion is experienced as deeply meaningful by many people. So are the arts and nature. A weekend in nature can have you feel as if an inner mechanism has been reset. So can attendance at an art event, whether a book reading, a modern dance concert, a visit to a museum or learning a craft. Whatever it may be, online courses are widely available. Instead of distracting yourself in your free time time, rather enroll and complete and on-line course.

A life that is experienced as meaningful, no matter the circumstances, provides resilience and energy and focus.

In my previous blogs on suicide, I have written more extensively on this.

For younger children: Most young children find shopping and eating in restaurants pretty meaningless. They find great meaning in imaginative play and freedom in the outdoors. Water and sand are their natural elements; combined with pretend play children enter a state of flow.

 

 

 

 

 

 

 

 

Helicopter Parenting/ Parenting in stressful times. (How our families of origin and the times that we live in influence our parenting styles.)

As I sit down to write on “Helicopter Parenting, I find myself thinking about the labels that we place on parents’ foreheads, about the amount of judging that we do. About the pressure that is placed on parents today to be “successful’. It is not only students who are pressurised by the demands placed upon them, parents are equally expected to be up-to-date with the latest trends, on top of this they find themselves held responsible for their children’s outcomes, more especially so when there is trouble. I hope to place “Helicopter Parenting” within this context, and to highlight the influences of vast amounts of information in an ever-changing, unstable and excitable world, leading to an increase in uncertainty and nervousness in all of us.

What makes writing about this topic difficult, is that complexity and chaos theories (to show off that I too am under the influence of trends) tell us that there is no more such a thing as a single cause = one effect. I am (also) pressurized to come up with something complex, yet unique and true. Our very own #Metoo era, also known in this instance, as performance anxiety.

Labeling

We like to name things; it is a way of pointing a finger at something. This is an apple, that is racism and thát is a helicopter parent. We name what we observe (or think to observe), and thus we make judgments – either good or bad, alternatively we are indifferent or ignorant.

Psychologists are master judges when it comes to human behaviours. They have labels for a variety of things that you wouldn’t even now existed. Which is why we have such a suspicious public: Who would want to their behaviours to be constantly labeled and judged?

As a young Psychologist I was like that. It was part of my own insecurities: labeling and judging was a way for me to feel that I knew something. As I made my own mistakes, as I continued to struggle with my own life, as I sat and listened to others for the 10 000 hours, and as my knowledge and skills improved, I became less and less faultfinding. Until finally, it led to my decision to let go of psychological terminology as far as practically possible (all the fancy labels that I knew); it was a great relief, especially in my practice.

One of the more obvious conclusions that I have arrived at (if you live long enough you discover most of what has been discovered before) is that as much as individual behaviours reflect their own personal histories, they reflect ancestral stories ánd the times that they live in (there is a complex mix for you to contemplate!). We are more determined by the personal histories of our ancestors and our wider environments (social, political, economical, fashionable), than we would tend to believe.

Familial History

Both my grandmothers had mothers who died when they were respectively 12 and 14. The 12 year old gained a wicked stepmother, and went to live for a while in another country. The 14-year old was sent away to live with an aunt. My mother was sent to a far away boarding–school when she was 11. I had two stepsisters whose mother had died when they were little. Together with my stepsisters, we were four children. We were all sent to far-away boarding schools when we were 13. Spot a pattern? A longing for home is a familial nostalgia. A sensitive spot that is readily triggered. (I can add more, but this is not an autobiography). If you look at your own families you could be surprised by the ancestral patterns playing out in your life. People who come to see me are often resistant – and at times annoyed- by the questions that I ask about their parents, and their parents’ parents (surely they have come here to talk about their lives now?). Yet, again and again, an ancestral wound comes oozing through.

There is some evidence that trauma can be genetically transferred from generation to generation in the form of altered brain patterning. We know as well that an anxious parent transfers anxiety or avoidance to their children. Avoidance (No problem is so big it can’t be run away from[1]), also learnt, can be a suppression of anxiety in a masked and hidden form. (Picked up by raised cortisol markers, a stress hormone, when saliva is measured). Multiple generations of anxious/neglectful/ abusive/ caring/joyful parenting can continue from one to the next, the habits of the foremothers being passed along like a relay baton.

How many of us have not decided to parent the opposite to our own parents, only to find that we have ended up doing something very similar?

On the times that we live in

When I was a teenager, self-harm was unknown to us (I was in a girls’ only boarding school where privacy was limited to the inside of your mind). We did not harm ourselves, even when in great despair, because we did not know that one could. Drug addiction was something exotic that hippies overseas indulged in – where we lived, hard drugs were not yet available. If you had penetrative sex before you left high school, this was a source of general exclamation, because not becoming pregnant was nigh impossible – no legal birth control was available to the unmarried. Bullying, although not non-existent, was certainly not endemic (no television, no internet, no social media). Instead those of us who dared drank too much at parties, smoked cigarettes, sometimes lied to our parents about our whereabouts, and bunked school to go to the beach or to the movies. The values of school reflected the values of our parents and that of the community, so that all of us clearly understood what was ‘good’ and what was ‘bad’. These were solid values and norms that we could kick against. Many of my generation felt empowered by the belief that we were going to change the social norms to create a better, a more egalitarian and less claustrophobic and restrictive world. Freedom!

Today the world is open and exciting, freer than we could have ever believed. It is also fractious, uncertain, unreliable, unstable.

Stress is our common language.

It is only natural that our behaviours will reflect that.

 What has this to do with helicopter parenting?

 “Helicopter Parenting”

It was bound to be labeled. Getting a catchy title is better than a pathological one. It is also known as “Overparenting”. Maybe it is ‘over-worried’ parenting. It certainly looks like an unfree and stressful mode of parenting.

With ever increasing amounts of information readily available and so much emphasis placed on parenting today that, what should have been a simple crossover from one generation to the next, looks to have become a competitive sport.

Anecdote

An ex-student comes to visit. We are both looking forward to her visit, as she and her husband have moved overseas. This is her first time home to introduce her baby, by now an 18-month-old toddler sprouting a small fountain of a ponytail from the top of her head. I have a soft spot for this mother; between us there is that special warmth that you spontaneously share with some people.

Except that we cannot have a conversation. The mother’s eyes are fixated on her little girl. My hallway (that you can see from the lounge) is a play space for my own grandchildren. It has a basket of dolls, a play stove with a tiny shopping trolley filled with pretend goods, and a big basket containing an assortment of toys. The little girl naturally toddles off to explore this bounty. Her mother follows.

“It is all right”, I say, “There is nothing there that can be dangerous to her.”

Yet her mother cannot relax.

We end up carrying the small stove and the little shopping trolley into the lounge, where we have a halting conversation whilst the little girl is guided, helped and directed by her mother.

Once they leave, both adults are exhausted. The little girl is fine, except for two mini tantrums (how much interference and interruption can a child take?)

I know that the mother strives to the best parent that she can be.

Maybe that is exactly the problem. Believing that every encounter matters. Believing that a child needs 100% focus and input whenever you are with them. Working too hard at it, having read too many webpages and parenting magazines and books that seek to advise and guide and produce evidence of just exactly how vital parenting is to your child’s future outcomes in life. It is all just too exhausting. Families are also getting smaller, allowing for more focus and value to the lives of small numbers of children (helicoptering six children would take more effort than two parents could manage). It is a common experience for working mothers to feel guilty, thus preferring to err on the side of over-investment  rather than possible ‘neglect’. If you add to this our troubled and unstable times that tick at the back of our heads like a bomb waiting to go off, and, as in many cases, being separated from your home country and original community…

Parents worry not only about now, they worry about the future, which is unpredictable and may well include your child moving far away too.

(If you add to this a family history of anxious parenting..Well, then…)

Stressed-out parents need to be reassured that children will not only be fine, they much prefer not to be interrupted and hovered over (Who does?). They naturally prefer more than one familiar caregiver – this is part of our ancestral heritage as much as crawling and exploration is! A mother taking care of a child on her own is a recent phenomenon in human history, and not a commendable one. Both parents and children prefer to be part of a larger clan, where they can engage in age-appropriate activities: Parents chatting and doing their business, whilst children are playing and doing their business.

In an interview many moons ago, the South African painter Judith Mason (1938-2016), in response to a question about being a working mother and working from a studio situated in her garden at home, summed it up well,

Children want a mother to be like a stable rock: something that they can move away from and return to, secure in the knowledge, that she will be there when they need her. [2]

 Extracts from Two research papers on “helicopter parenting”

I hesitate to include these, given my advice on not reading so much!

The findings are interesting though, because they add to our growing awareness that young adults are becoming more anxious, more depressed and less resilient, instead of the other way round.

 Helicopter Parenting and Young Adults’ Well-Being: A Comparison Between United States and Finland.

Ming Cui1, 2, Hille Janhonen-Abruquah2, Carol A. Darling1, 2, Fiorella L. Carlos Chavez1, Päivi Palojoki2 1Florida State University, Tallahassee, USA2University of Helsinki, Finland. Article first published online: October 3, 2018.   https://doi.org/10.1177/106939711880

Helicopter parenting, defined as a form of overinvolved parenting of young adult children, is shown to be associated with young adult children’s well-being. Furthermore, the phenomenon of helicopter parenting is increasingly evident across various cultures. In this study, the association between helicopter parenting and young adult children’s well-being problems was examined, and the associations were compared between samples of American and Finnish young adults. With a sample of 441 American and 306 Finnish university students, results from path models suggested that maternal and paternal helicopter parenting was associated with university students’ symptoms of anxiety and depression, life dissatisfaction, and emotional dysregulation. Furthermore, even though the mean levels of helicopter parenting were lower among Finnish parents as compared with American parents, the associations between helicopter parenting and young adults’ well-being problems were, in general, equally significant.

Parent and Child Traits Associated with Overparenting

Chris Segrin1, Alesia Woszidlo2, Michelle Givertz3, Neil Montgomery4 (2013). Parent and Child Traits Associated with Overparenting. Journal of Social and Clinical Psychology: Vol. 32, No. 6, pp. 569-595. https://doi.org/10.1521/jscp.2013.32.6.569

Overparenting involves the application of developmentally inappropriate levels of parental directiveness, tangible assistance, problem-solving, monitoring, and involvement into the lives of children. Based on theories of family enmeshment, effective parenting, and personality development, this parenting behavior was hypothesized to be associated with negative traits in parents (i.e., anxiety and regret) as well as in young adult children (i.e., narcissism, poor coping styles, anxiety, and stress). Participants were 653 parent-adult child dyads from 32 of the 50 United States who completed measures of overparenting and maladaptive traits. A latent variables analysis showed that parental anxiety was positively associated with overparenting, and that parental regret had an indirect effect on overparenting through greater anxiety. In adult children, overparenting was associated with higher levels of narcissism and more ineffective coping skills (e.g., internalizing, distancing). These ineffective coping skills were associated with greater anxiety and stress in young adult children. 

[1] Linus,  in the cartoon series Peanuts.

[2] I could not find the exact reference, so this is an approximation. In a recent interview, her daughters described her thus: “If you had to describe her to someone who never knew her, what would you say?” Eccentric, fierce, gentle and magnificent.What a testimony!                                   https://www.litnet.co.za/interview-daughters-judith-mason/

 

 

Sharing secrets from therapy: When a parent comes for a first interview, what is that I am looking for? Three probing questions reveal parental attitudes that psychologists believe to influence problems.

I receive a phone call from a parent. S/he is nervous, apprehensive. A parent who phones about a problem with a child normally feels a little embarrassed, maybe an anticipation of being shamed: How come their child has this problem and all other children in the group seems to be fine? I understand this, so that in my response I hope to be generous and kind.

 

If at all possible, the first interview is with both parents. A parent who is “too busy”, who “can’t take off time from work”, whose “work schedule is too hectic”, I speculate to either being blocked by the other parent or one who is trying to avoid a potential uncomfortable confrontation- something along those lines. So I use some tactics to get that parent in. Not because I want to prove something, but if a child has sufficient contact with both parents, I need to see both to get an impression of the child’s familial world. Where someone other than a parent is looking after a child, I mostly do a home visit as well.

But back to the first interview. What am I looking for?

 

Three questions revealed:

One of the first questions that I ask goes something like this,

I do not know your child? Can you describe your child to me?

Here is a sample of some answers from real life. Spot the difference:

  1. a) Puzzled: “Oh, she’s a child, she is just like a child you know.”
  2. b) Big sigh: “ He doesn’t listen. No matter what you do. He is never still, not even when he sleeps. We think he has ADHD. And he is aggressive, even with his little sister. We are scared that one day he is going to hurt her. Doing his homework is one big battle.”.
  3. c) Face lightens up (a sense of relief to be able to talk): “You know, the school asked us to see a Psychologist. She bullies other children. This is such a worry to us, because she can also be very kind. She loves to help with the chickens at home. At times she can be so sweet, and then at other times she throws a huge tantrum and there is nothing that we can do to calm her down. She is smart, she knows the names of all her cousins and uncles and aunts, even those she do not see often. But when they do come to visit, I think she is jealous, because she does not want to share her toys. Sometimes she hits the other children.”

Parents who can provide a nuanced description of their child, with both positive and negative examples, and who have some idea of why certain behaviours happen (“I think she is jealous’), already have the first step in place: Seeing your child as a nuanced person and not as a stereotype, is a first step in the right direction. It is one of the aims of therapy.

Allow me to defend the other parents:

The more stress you have in everyday life, the more difficult it is to “see” your child. When we are stressed, we cannot see- not our children, or the wood from the trees.

Parents quite logically think that they come to see you because their child has a problem, so they provide a list of problems. Yet, an attuned parent, will want to defend their child against a totally negative view by others, so invariably will add some positives.

I have worked with many grandmothers who look after aids orphans, sometimes as many as 14. It is enough of a challenge to keep these children clean and fed, they must see each child as an individual as well? Yet, working with them has been my greatest joy and a source of deep satisfaction. Because given just a little support, they do, they do!

Question two: When you lie awake at night, and you worry about your child, how do you understand your child’s problem?

What am I looking for? More or less the same scenario applies as in question one.

A parent who can make a connection between their own behaviours and a child’s behaviours is on a substantial way along the path towards a solution. This relates not only to parental behaviours, but also to outside influences as well. Multiple moves, divorce, bereavement, parental mental health issues, school environment, cultural context; all of these have a strong impact on our children.

Fluidity in thinking and logical connections. If you shout and beat or belittle your child, then aggression in a child is a logical response (If someone shouts at you and belittles you, how would you react? How come we think children are a different species from ourselves?).

What I would prefer not to hear:

“”It is the influence of bad friends”

“They deliberately pick on her at school”

“S/he is such a sensitive child ”

“ I am afraid it is in his genes” (preferably from the opposite parent, especially in divorce)

Why not? Could this not be true?

Maybe, to an extent. But placing all influence outside of the child’s control/ contribution, is a way of shirking responsibility and/or ‘growing’ victimhood. This attitude, once fostered in a child, becomes an adult habit, whence it will increasingly frustrate and irritate you as well as undermine the child’s progress and relationships.

Social media and the Internet play an increasing role here, as exasperated parents trawl for answers.

Caveat

I am not trying to blame parents. Believe me, at my age I understand that we are all flawed, that we all make mistakes, that with hindsight, all of us as (myself certainly included), would have done specific things quite differently.

One of my benchmarks of a successful outcome, is a deeper and more nuanced understanding of the systemic nature of a child’s problem. That a child does not exist in a vacuum, but responds to a multitude of stimuli – both internal and external. A child is not a stand-alone act.*

Often, deep down, one parent knows this, but for a multitude of reasons, does not feel free to own it.

* How do I know this? If a child can respond differently inside the room with me than outside (e.g. sit still, not interrupt, can focus on a task), then the problem is not only internal to the child, but in the child’s reaction to an outside world. Children in therapy play out an amazing inter-connectedness of all things as well as a depth of feeling that to this day leaves me in awe.

Question three: Can you describe what have you tried thus far, what has worked and what was unsuccessful?

By the time that a child ends up with a psychologist, the problem is usually advanced, and many solutions would have been tried. Also, by this time, a typical pattern of behaviours around the problem would have been established. Parents and teachers would have tried multiple interventions. This is a way for me to understand how they have made sense of it all, as well as what they have tried thus far. One of my favourite maxims is: The problem is not the problem, the solution to the problem is the problem.

This question seeks to understand the relationship between parents and a child, as well as the “solutions” and the sequential logic applied. I can also trace the influence of the Internet and topical solutions (e.g. empty chair). It is my experience that inconsistencies (one day you shout at a behaviour, the next day you try to reason, the following day you are to tired so you just ignore it), a hostile attitude, and an over-emphasis on the problem are some of the more prominent markers of poor solutions. These types of “solutions” often lead to additional problems like defiance or despair.

It matters, of course, that I know what has been tried and what has failed;  I do not want to prescribe what has already been proven not to work.

Mostly this question has to do with helping me get to a deeper understanding of the relationship around a problem, as I want to lift the despair that has built up. Optimally, a good solution should empower both a child and it’s parents, it should enhance the relationship between them, must build more autonomy and competency in a child. Without experiences of autonomy and competence , and without hope for improved family relationships, both parents and children are bound to fail, no matter how smart and topical the solution.

 

 

 

 

 

 

 

 

Are we overemphasizing Emotions? Soothing & Problem-solving without an emphasis on emotions.

Are we placing too much emphasis on emotions?

Lets first talk about emotions:

Talking about emotions is one certain way of feeling better. Of lightening up. This depends, of course, on the reaction of the listener.

An accepting ear is required.

We all have experience of the discomfort when you share something personal and the other person responds by a) disagreeing/dismissing or criticising (“I feel as if my whole life has been a waste.”  “Oh, that’s not true”,   “Don’t be ridiculous”  b) giving a lecture   and solving your problem cheaply c)  retorting with their own worse version and d) misinterpreting what you are saying.

I used to say about my own mother (she has long passed, bless her), that if I had problem, I could not share it with her, because then two of us would have a problem (which adds e) to above….Becoming highly upset themselves).

From my practice it is clear that a frequent problem in depression is the not talking about things that really matter. This is a habit that can run in families, from generation to generation, and through villages and cultures.

Not being able to identify our own emotions as well as those of others, is a significant social handicap.

So, I am all for emotions – after all my profession depends on the ability to listen closely, on being attuned to a myriad of possibilities within a conversation.

The role of Emotions

  1. Not being able to name emotions or to acknowledge them, is probably thé hallmark of ineffective emotion regulation. If I were to write an essay on “how not to be able to soothe yourself or others”, I will probably write , “ignore emotions” as no1.
  2. The current emphasis on Mindfulness, is exactly the practice of experiencing an emotion and not running away from it, nor being overwhelmed by it. (We run away because we fear that we will be overwhelmed by it). Developing mindfulness is the building of the capacity to stay with an emotion and  to remain calm at the same time.
  3. It is about not being judgmental about what you or others are experiencing (a big one this).
  4. Not being judgmental about your own emotions, is one capacity that we all need to build, critically so when you have experienced trauma or have a tendency to overreact.
  5. It is not for nothing that Mindfulness is trending currently: In the times of great turbulence and uncertainty that we are living in, it is a logical and healthy response to threatening universal stress.

To find out more, check out: https://www.mindful.org/what-is-mindfulness/ 

Examples of how mindfulness helps us to remain calm, even when we are dealing with our own emotions: https://www.psychologytoday.com/us/blog/fulfillment-any-age/201707/research-suggests-cure-neuroticism

Yes, it is important to be able to name an emotion appropriately. After all, this is what therapists do. Sensitive parents and partners do it naturally. The deeper the distress, the greater the significance. In my previous blog on Emotion Regulation, I describe this development in greater details.

BUT

Being able to air an emotion is good, and occasionally all that is required,. However, it is a first step, and certainly not a necessary condition for feeling better. It is insufficient when you have to solve a real problem.

As a matter of fact, an over-emphasis on emotions is one of the “symptoms” of a neurotic person. As is an overuse of the word “I”.  (More about this later in this blog)

First some anecdotes

I overhear a mother on a playground responding to her son, “But if you don’t tell me how you feel, I can’t help you.”

How I wished I that I could respond like a tennis umpire: “Off!”

My daughter, aged 16, went off to boarding-school. She was a weekly boarder, meaning that she spent weekends at home. In the first six weeks of her stay, she would complain bitterly in the car on the way home. On one such Friday, after listening to her, I replied, “If you are really unhappy, we can make a plan.”

“But I am not unhappy!”

“Then why do you complain so much?”

“I can’t help it, you listen so well.”

!

The son of a school friend, who was rather awkward and nerdish, struggled to find a date for his final year high school dance. My friend felt really sorry for her son. How dejected he must feel. His 15 year old sister, who later became a successful occupational therapist (for a good reason as we shall see) had a better plan:

“Let us go for dancing lessons. I will go with you. And if nobody else want to go with you to the dance, I will.”

His sister is not only inventive, she is also very good-looking.

It turned out that the young man had talent. He and his sister dressed up to the nines for the dance, and captivated their peers. Ever since, he is a popular choice for dances, and sought after by girls, who incline towards good rhythm anyway.

The roots of the emphasis on Emotions

Carl Rogers (1902-1987), an American humanist,  is the father of modern Psychology (post Freud and Jung). His emphasis on empathic listening as the central tool in therapy is still valid. After all, research shows that the experience, “My therapist understands exactly how I feel”, remains the best indicator of a successful therapy.

In the 1980’s a book arrived on the scene, How to listen so kids will talk, and how to talk so kids will listen. It was a bestseller.

It gave the following advice: 1. Firstly, name the emotion that the child is experiencing in an accepting way (“I can see that you are upset/angry/sad/shocked….).

The best part about this advice, is that it helps you to focus on the child before you focus on the behaviour. The same goes for you: When you are experiencing a strong emotion, take a moment to ask yourself, “What is it?”

You may be surprised. Once you hit the right emotion, you will feel it, AND you will experience some relief. Be careful of stereotypical labels:

“I am depressed.”

Yes, but what does that mean?”

“OK. I am sad.”

Sad about what?

This matters, because the correct naming of the emotion, helps with the correct action (the change in your behaviour) that has to follow if you want to feel any better

This book by Adele Faber and Elaine Mazlish (still in print), was hugely popular, and paved the way for a more cooperative form of parenting. Much of the advice remains useful. Like all new developments, it carried within it seeds of a new set of problems. (An over-emphasis on emotions, the idea of a forced choice has limited potential, and my pet-gripe: another brick on the wall of artificial parenting).

A short cartoon on you tube provides an effective summary of the book

https://www.youtube.com/watch?v=iU7Z6v128CI

I think I have covered myself…

An overemphasis on Emotions

To return to the examples that I gave at the beginning of this blog: The effective intervention (the teenage sister empowering her brother through dance) does not place the emphasis on the deflating emotions – as opposed to the negative example where I was being over empathic to the negative experiences of my daughter, resulting in an increase in her telling of these tales.

It is certainly not necessary to always name feelings. Especially in the normal course of everyday life. Hopefully it is clear from the anecdotes that a good solution redresses an implicit problem.  Being able to identify the underlying problem, is as important as accepting feelings.  A very good solution, empowers.  If a child is not selected on a team, and is upset, it is appropriate to reflect on their disappointment and possible feelings of “being left out”. (Please note: this is not a catastrophe. I forgot to write about not inflaming emotions.) If the underlying reason is insufficient skills, you have to decide: is this something that can be achieved and thus can be directly addressed, or should you find another activity that will suit your child’s aptitude better. A trip to the theme park to make them feel better, is no solution.

Having trouble making friends? Feeling side-lined and rejected? Being bullied? One of the advantages of search engines, is that you can google why this could be so, and what you can do about it. (In later blogs I will write about grief and trauma.)

Because we tend to respond to negative feelings more often than to positive ones, this leads to an imbalance of focus, which leads to neurosis[1] (unhappiness).

An emphasis on “I” plus an emphasis on feelings, is a feature of a  “neurotic” person Which may be why teenagers have such a propensity for being unhappy and why we all need outside interests to keep us sane.

Here are two consequences of an over-emphasis on emotions that you want to avoid

  1. Self-pity. A nearly natural response to bad things happening to you. Why me? (Would it be better if it was someone else? “Yes, someone deserving. I don’t deserve this.” ) Self-pity, even when it is realistic, is unfortunately a non-helpful coping mechanism. Taking on this identity is to take a shovel and to dig yourself in deeper.
  2. Victimhood. This is what you become if you indulge in “me” talk. When you  believe yourself to be the unfortunate victim of others. Even  to the extent that this might be true, I have learnt over the years that this is never entirely true after the age of 12. And the older you get, the less true it is. Best is to accept from an early age that you are co-author of your own life story. This is good news! Much better than the alternative.

Here is a somewhat wordy extract from recent research:

Depressive symptomatology is manifested in greater first-person singular pronoun use (i.e., I-talk), but when and for whom this effect is most apparent, and the extent to which it is specific to depression or part of a broader association between negative emotionality and I-talk, remains unclear. Using pooled data from N = 4,754 participants from 6 labs across 2 countries, we examined, in a preregistered analysis, how the depression–I-talk effect varied by (a) first-person singular pronoun type (i.e., subjective, objective, and possessive), (b) the communication context in which language was generated (i.e., personal, momentary thought, identity-related, and impersonal), and (c) gender. Overall, there was a small but reliable positive correlation between depression and I-talk (r = .10, 95% CI [.07, .13]). The effect was present for all first-person singular pronouns except the possessive type, in all communication contexts except the impersonal one, and for both females and males with little evidence of gender differences. Importantly, a similar pattern of results emerged for negative emotionality….. These results suggest that the robust empirical link between depression and I-talk largely reflects a broader association between negative emotionality and I-talk. Self-referential language using first-person singular pronouns may therefore be better construed as a linguistic marker of general distress proneness or negative emotionality rather than as a specific marker of depression.

Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S., Mehl, M. R. (2018). Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis. Journal of Personality and Social Psychology. Advance online publication.http://dx.doi.org/10.1037/pspp0000187

A final short anecdote:

A grandchild was jealous at the arrival of a new sibling. She tells my husband, with some hint of anger, “I do not like my sister!. He replies, with a hint of compassion“ Oh dear, I have bad news for you: One cannot choose your family, you just have to learn to live with them.”

I still like this reply as it neither denies nor opposes her experience. There is an implicit acceptance of her experience, but it is placed within a practical, universal frame that helps her to contain and guide her feelings.

To Summarise

  • Emotions are good things. Being able to correctly name what you are feeling is a sign of positive mental health. Just don’t overdo it.
  • To soothe yourself or another, accept the emotion calmly and with curiosity. It is the beginning of regulation.
  • Keep a check on that inner barometer that veers towards measuring feelings every hour.
  • Go slow on the use of “I”, You should not be the main object of your own interest. (Is a sure way of losing friends as well)
  • Make a plan that can redress the underlying imbalance. The more ingenious the plan, the more power and joy  you will reap.

 

[1] Neurosis, a slightly old-fashioned term, is one of the big 5 personality traits. To read about them, you can look up:

https://www.verywellmind.com/the-big-five-personality-dimensions-2795422

Depression in Children

Writing on suicide, I have to write something on depression……Depression is the common cold of the therapy room… a densely entangled ball of wool.   There exists after all, a whole Encyclopedia on depression  (It is old, but yes, it does exist).

Here are some thoughts on depression in children. These are the things that I would look for to start out with, when I see a child. The youngest child whom I saw in practice, who was clearly depressed, was two and half years old. I have seen babies in public who look depressed, but I do not see children under two in my practice.

  1. Children are highly susceptible to the moods of their parents. Here is where fathers seem to have as big an influence as mothers. Moods, including depression and anxiety, are  contagious. This truism, which we all now from experience (try living with a person with somber mood for a month, and see how you feel) , is often neglected when we reflect on children. Too often home atmosphere gets factored out of  genetics. We know today that a gene is not a stand-alone act: A gene requires an environment to be triggered.  One of the very first question that I would ask is, “Who else in this family is sad?”

2. The eyes of a parent and the tone of voice when they look at a child,   the ways in which a child is touched, all these are live-giving or life-robbing forces. Irritation, criticism, longing, dread, sadness and dismissal – these are all purveyed through our senses. So is acceptance, gladness, enthusiasm, affirmation, challenge, joy, security.

3. From the age of nine, children are increasingly susceptible to the opinions of their peers. Tweens and adolescents have an intense need for peer friendships. To have this need  met (really, it feels like an innate drive), is as vital as food and water to the human. Without it, we are cast out in limbo. Having no friends is being out in the darkness and the cold.

4. Depression in children, much like in adults, is linked to insufficient expressions of autonomy and competency that are being blocked in some way. Sometimes this is due to overprotection, sometimes to an authoritarian environment, sometimes simply to a collapse as a result of negligence.  This means that trust in the self as a potential change agent as well as in significant adults to be able to help us, is broken.

5. On Coping well, or not coping: People who cope well, become problem-solving when in distress. Those who don’t become emotion-focused. Interesting finding this, especially at a time when so much emphasis is placed on emotions. The capacity to make a plan, is key to experiences of self-determination. Self-determination/Autonomy/ Competency these are all room-mates in the headspace of a resilient child (and adult). This is why both overprotection and authoritarianism are so harmful; they rob children of a multitude of experiences of self-discovery, that lead to competency.

And of course this is tricky: Children who get too much power too soon, are typically anxious. It is truly a matter of Goldilocks and the three bears: Not too much and not too little. I have written extensively about this in my previous blog on Will, Power and Motivation..

And by the way.. Children who are bullied are typically children who overreact to small slights. This sets them up for increasingly bigger slights.

Why do you all tease that child so much?  “We can’t help it, he responds so well!”  (Two boys, aged 11, in reaction to my question. This finding has been replicated in research).

6.  Like adults, children with persistent low mood have repetitive negative thinking habits, with self-blame and feelings of inferiority topping the list. Once these thoughts become embedded, they take on a life of their own, affecting not only mood, but also physiology so that a downward spiral occurs, with e.g. lowering  of Dopamine and vitamin D levels, making an upward curl increasingly impossible. If these thought patterns persists over time, bizarre thoughts begin to develop and a child moves into the psychiatric realm.

7. I wrote about the research  findings on the influence of internet use on mood  in my previous blog (Suicide and Children).

8. The death and absence of a parent or a sibling, child abuse (physical and emotional) , domestic violence, pathology in a parent, severe neglect ,and the stressors of poverty all take their toll.

The two and half year old:

His mother suffered from unresolved trauma and grief. As a child she had suffered serious, longterm trauma. This mother was a competent person who had risen above her circumstances. Yet, when her first child was born, this brought back all the horrific memories of her own childhood. She loved her baby, but at the same time was overwhelmed by it. She had coped until now by controlling and structuring her life in a disciplined and focused manner: As long as she was in control, she could control the past. Well, we all know, that there are few things in life as unpredictable and fluid as a baby. And the more you try to control a baby, the worse they can become.  (That is, if they do not collapse; giving up exploration and resistance). So here we had a sad mother with a sad baby.

On the upside

The younger the child, the faster the restoration of joy can be. The simple act of a parent taking care of their own needs can free a child almost instantaneously.

Having adventures together (canoeing, sailing, hiking, camping, fishing, hunting),  and finding interesting things to do (joining a museum club, building a shack in your back yard, sewing outfits for a doll, making picture books, baking scones), all these can make a significant difference in children’s lives. Much easier than with adults!

A child who is not popular at school, can gain enormously from doing well in an after school activity. Many a child has been saved by karate and music.

A note on finding a good Psychologist

It is of course important not to overreact to normal unhappiness in a child (see note on overreactions above!). It is normal to feel aggrieved if you are left out of a team, or have been on the receiving end of nastiness. Important is to be able to bounce back after a short period of time and to gain some skills in the process.

However, a persistent low mood, that does not seem to lift easily, with positive periods seeming to be short-lived, requires assistance.  The same goes for withdrawal and aggression. Consistent aggression is as much as sign of depression in a child as is withdrawal. Now I immediately need to write that all of us who work in the field are familiar with ‘false brightness”. This is the child who is ‘always jolly’, who masks deep despair behind a mask of fake joy: It is typically the clown, the joker, the one who laughs too loud too often, who dismisses any negative feelings, hiding behind a mask of pretend happiness.

A good child psychologist will include parents in the process. Will help you to see and to understand and to respond in different ways. Will give you “homework” to do, will not pathologise your parenting, but help you to make sense of how you and your child can be different together as well as apart, so that life can be better for both of you.

For this is true: Without each one of us responding differently, no difference is possible.

*

 

Children and Suicide (1)

In the past ten days, two grade 7 boys in my region committed suicide. I do not know the family’s, but I do know the schools.  Both are schools that I often recommend as examples of vibrant, caring and committed community schools, with clear anti-bullying protocols in place. Suicide, can happen anywhere. When it happens to primary school children, a whole community reels. It is as if we have all failed those children.

In my previous blog, I wrote that I could blog a series on suicide. Little did I think that I would.

I would like to emphasise that I have no knowledge of the two young boys who tragically took their own lives this past week.  What I am writing here is knowledge that I have of other young people. Suicide in young people can be an impulsive act, they mostly don’t comprehend the repercussions of serious acts, and most often (actually always in my experience), the young people who were contemplating suicide, had the idea that it would be helpful to their families – that they were a burden to their families, who would be relieved once they were gone. Our old enemy, “not speaking about”, combined with loneliness and shame remain the cornerstones of the despair.

Obsessions and Addictions 

Thought of suicide, once they have taken root, can acquire a hypnotic pull. Like the sirens calling, or the snake in the waters, beckoning young maidens to a watery grave, once thoughts of suicide have taken hold in the mind, they have an obsessive and hypnotic quality.  A young girl once described a puppet master, who had taken over her mind, from where it controlled not only her, but also her family.  A young student described it as a wolf-like creature that had become his best friend, and who would accompany him to the end, hence he was not afraid. It reminded me of Anubis, the ancient Egyptian jackal dog, who was a guide to the afterlife.

From http://egyptianmythology.org/gods-and-goddesses/anubis

Anubis was a jackal-headed ancient Egyptian god of the dead and of the transition between life and death. He was both the ruler of the dead in the underworld and the judge who determined the lot of the deceased in the afterlife. (Vector image of Anubis below by Jeff Dah)

I show you this, although it is spooky, because this is how it can become to the person.
Social Media and the Internet
Depression in young children is increasingly linked to social media and internet overuse.  Teenagers who are addicted to the Internet are more likely to develop depression or other psychiatric problems than teens who are classified as normal Internet users.
Below is a research article; I have copied the results and the discussion quite extensively, as it speaks volumes:
From Psychiatry and Clinical Neurosciences 2016; 70: 405412.
“Internet addiction: Prevalence and relation with mental
states in adolescents” 
Available online: https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12402
Mental state of children with Internet addiction

The mean total score of the GHQ (General health Questionnaire)was 4.3 ± 4.6 in the non‐addicted, 8.8 ± 6.0 in the possibly addicted, and 12.9 ± 7.4 in the addicted groups (Table 2). The total score of the GHQ differed significantly between the three groups. Post‐hoc analyses revealed that Suicidal Depression scores significantly differed among all three groups. The General Illness, Somatic Symptoms, Sleep Disturbance, Social Dysfunction, and Anxiety and Dysphoria scores significantly differed between the non‐addicted and possibly addicted and between the non‐addicted and addicted groups.

The most important issue in Internet addiction in adolescents is associated with the deterioration of mental states related to Internet addiction. The present study revealed that students with Internet addiction experienced more severe mental states. The addicted and possibly addicted groups showed more disturbed mental states than the non‐addicted group in all subscales of the GHQ. In particular, the addicted group had more severe depression and suicidal ideation than the other groups. The relatively high IAT (Internet Addiction Test) scores in the possibly addicted group were positively correlated with depression and suicidal ideation.2On the other hand, the percentage of subjects within the pathological range was greater in the possibly addicted group than in the non‐addicted group. These findings indicate the necessity of paying attention not only to addicted but also to possibly addicted adolescents. Previous studies reported that symptoms of Internet addiction were comorbid with psychiatric conditions, including suicidality and depressive symptoms,8 and that adolescents with problematic Internet use experienced a higher incidence of depression at 9 months’ follow‐up compared to other adolescents.23 Intervention of Internet addiction may be beneficial in the treatment of psychiatric disorders associated with Internet addiction.24 The findings of the present study suggest that Internet addiction contributes to depression. It remains unknown which adolescents might be good candidates for intervention that could prevent comorbid mental problems associated with Internet addiction. It is necessary to prevent Internet addiction in order to attenuate these detrimental effects on the mental health of adolescents.

Finally, we need to determine an effective target of intervention in terms of electronic devices. We suggest that accessibility to smartphones is one of the most important factors in Internet addiction. Smartphones are very convenient as they can be used while lying in bed to surf the Internet or watch videos. The superior handiness and light weight of smartphones as compared with other electronic devices (such as laptop computers) makes them particularly attractive.  In the present study, 38.8% of male and 46.2% of female junior high school students owned a smartphone. Moreover, the duration, rather than the first‐time usage of smartphones, is significantly associated with Internet addiction in early teens. In order to prevent Internet addiction, health‐care professionals, school administrators, and parents should be aware of this finding. In addition, the mental health education curriculum for junior high school students should consider proper use of the Internet, and how misuse of the Internet might affect students’ mental health.

 

 

 

 

Making Sense of Suicide

I could write a whole series on suicide, because it says so much of the times that we live in. In this piece I describe two very different people who crossed my doorstep: An adolescent girl and a mid-career professional man. Both confirm my professional conviction  that all behaviour is logical. That symptoms are not simply “something onerous to get rid of”, as Jung said. That symptoms are deeply meaningful, and often the most authentic voice of ourselves that has remained, when the battle inside has been particularly fierce.

 Is Suicide about despair? Thus asks a friend.

Hannah Arendt, a German-American philosopher, wrote in The Human Condition (1958),

“Our short, to death-speeding life, would result in inevitable death and destruction, if we did not possess over the capacity to interrupt this death march, and begin something new.”  

“To begin something new is the best ability of a human, politically seen, it is the identity of human freedom.”                                                      (own translation from the Dutch text)

Suicide is about not believing that something new is still possible for you.

I often think that suicide seems to point to something obvious that we are not seeing. A road sign pointing somewhere conspicuous, only we are staring down the wrong road?

At the same time as I am aware of those who take their own lives, I am aware of the effect on the people left behind. This type of death can take up permanent home in those who stay behind, deep Sunday blues, come to stay, week in, week out.

As I write this, the successful American fashion designer Kate Spade commits suicide. A chic, successful businesswoman and mother. I look at a photo on my phone that shows her with her young daughter. They look young, at ease, lovingly groomed, as if the world is bright and they in it.

As with depression, suicide is not one thing, but many. The lonely old man, the young man diagnosed with aids, the intense teenager, the mother with postpartum depression, the woman with swinging moods, and the celebrity with overwhelming feelings of inner emptiness – they may all share deep despair combined with a sense of futility, but their pathways, biological and biographical,  will be different.

The highest suicide rate in the world is amongst the Inuit (whether in Russia, Canada, or Greenland), followed by the Baltic states (Russia & Lithuania leading the way). The lowest rates are found in the Caribbean, with Antigua in some years having none. The highest rates are amongst young white men (15-24), a typically at -risk group in all countries, with the other peak for old men. The lowest rates of all, is amongst Black woman.  (Stats from WHO & Suicide.org.  Reliable stats are not available for most African and Muslim countries. These findings thus reflect countries with reliable stats).  Black woman are a particularly robust group, with the lowest rates in the world.  Black women share a strong sense of belonging (A Sisterhood. “Somebody always understands how you feel, because they are in the same situation, and they encourage you.”),  embedded faith ( providing meaning, support and self-esteem), and an enduring conviction of a wider responsibility.  (Spates, K & Slatton, B.C. Socius (2017). I’ve Got My Family and My Faith. Black Women and the Suicide Paradox. SOCIUS: Sociological research for a Dynamic World: ASA.)

I write this, because we tend to think of suicide as an individual thing.  Of the individual being “sick”.  But it so seldom is just the individual The young Inuit men represent something that has gone wrong in general. The resilience of Black women represent something core, something vital.

Loneliness.

“The biggest problem on this campus, is loneliness”, says the psychologist working on a big university campus. 30 000 Young people milling around every day.  Combine this with a meme of  non-interference:  “It is none of your business”. “You can’t interfere”. “They must make their own choices.”  “ It is their life. ” “Best is to leave them alone.”  (sic). And so we do.

Is suicide depression gone way, way too far?   At a conference some years ago I listened to a lecture on the correlation between geomagnetic storms and suicide.[1]   Moderate associations between major depression and variously, inflammation, omega-3, vitamin B12 and vitamin D levels have also been shown. Specific anti-depressants can have an opposite effect on individuals, where they can lead to a calamitous drop in mood. Please note: this is not an anti-anti-depressant statement; it simply means: if you are taking an anti-depressant, and then things get worse (the beckoning of the dark hole gets stronger), PLEASE be aware that you may have to change the type that you are taking, and to do so under professional guidance

Most usually the focus in suicide is on individual factors, whether biological or psychological. Mostly, the reasons are multi-faceted. Suicide can be a final heroic act in the absence of the possibility of Euthanasia. Societal shame can become a force that pushes an individual over the precipice, where the shame should be on the group, but instead is poured out on a person. Rape, Postnatal depression, Post Traumatic Stress, acute Bipolar episodes – all of these can be overwhelming experiences that only death can seem an answer to.

What differentiates ‘normal’ loneliness from suicidal loneliness?

Feelings of despair, like billowing smoke, can rise so strongly, that we are unable to contain them.

The lonely girl

A young girl of 16 is brought by her distressed mother. Her mother found an entry in her daughter’s journal, stating that she is going to commit suicide before a certain date. The young girl, fashionably dressed with torn black jeans, has no friends. None. I would like you to imagine that: Imagine one whole day in high school without one friend. Now imagine a week like that. Turn this into three years. Would you not consider suicide? Why does she not have any friends? Is there not even one single other lonely girl in her school that she could have connected to? Somehow not. Both mother and daughter do no know why this is so. Does mother have any friends? It turns out that mother has acquaintances, but not one good friend.  How do they understand this? They don’t.

Making sense of yourself from the outside, and of others from inside:

Here we have what is known as the “absence of reflective functioning (RF).”  RF refers to the ability to understand our own minds as well as the minds of others. Previously named “mind-mindedness”, it refers to the capacity to hold another’s mind in your mind. To understand how others are feeling, and that they have minds different to your own, and to take this into account in your interactions. A simple example is, being irritated when you are stressed, and understanding that. “I am sorry that I am so irritated, but this deadline is really bothering me.”  It is as much about speaking out (not avoiding uncomfortable feelings), as it is about being able to identify them. The absence of this seemingly simple capacity has huge consequences for socialisation as well as self-regulation. The fact that this mother could not make sense of her child’s inability to make friends, nor of her own, does not make her a bad mother. Having inherited this from her mother, who probably inherited it from her mother…

The absence of RF is always somehow connected to unresolved loss and grief. Makes sense doesn’t it? We all have some experiences that need to be resolved. How do we resolve them? By talking about them, by sharing them as stories about our own lives, by someone listening, and sharing their own stories in turn. Sometimes we have to pay therapists to play this role.

It shows how important, how vital,  the minds of others are to our own well-being. And how we need to have deeply personal conversations with at least one person, why peer friendships are the bedrock of our own mental health, and how we need to be connected to others to live ‘undespairing’ lives. It also partly explains why the lonely elderly have such high rates of suicide.

Culture & Integrity

He is attractive. I did not expect this. He is important. I do a sharp inhalation.

In South Africa, under apartheid, black people were not allowed access to office positions. They could teach or preach or nurse within their own communities, but that was mostly the highest they could go. Bantu Education was used as a means to limit progress. We have the first visible generation of professional and otherwise successful black people only now, 25 years after the abolishment of apartheid.

He is the first person in his village, and the first in his extended family, to attend university. Talented, he obtains postgraduate qualifications, with bursaries to study overseas. This means that he is the first person to fly, the first to travel overseas, the first to demonstrate that “blacks are equal to whites” (his words) in his village. In his culture this means that he has held up the honour, not only of his family, but that of his community. He has risen in the corporate world through his own merit. He is a man with a quiet dignity.

Except that he is gay.

Married, with children.

Religion is the bedrock, the warp and woof that has held his family together through times both rough and smooth.

His wife, a committed secondary school teacher, cares deeply about their community, their children, and him.

Homosexuality is a sin, not because his family is judgmental by nature, but because it is Gods’ word in the bible.

He comes every week. At least here he can talk about it. At least here it is said.

Is this a good thing or a bad thing?

He commits suicide. He does.

Mea culpa

He did not talk about suicide. This is my excuse. When people talk about suicide we have a set of protocols in place. We contract, become practical. I did not know what was the solution to this man’s problem (do you?). I believed that as we sat, we would, slowly but surely get to a new place. A place where it seemed possible to breathe. Sometimes, often times, it is true; we have to do a wheelchair adaptation (you have to accept real harsh limitations to your life and learn to live with them). Was it not true after all, that many people in the past were homosexual, but could not live that identity? Only problem is/was, many people today do.

After his funeral, I had this brief fantasy that his family will one day contact me to enquire about him. Maybe his children, who could understand. But then I thought, they know anyway:

You see, he had this gay voice.

A concept that has helped me a lot is David Rosen’s idea that when we talk of “suicide” we should think “egocide” … what needs to change in the person’s approach to the world or their life?                           A friend, a psychiatrist, in an email to me.

I think what my friend also means is that we have to think of ourselves as being able to be different- that there exists a real possibility that we could be a different person to the one whom we are now. That if this possibility seems impossible, then death may seem the only option out.

The antidote is integrity. Big word that. I suppose that to live a life of integrity means one where our inner understanding of self and our outward expression of it, are in sync. When there is a disconnect, a sense of impossibility of such a life, then escape may seem the only option.

Concluding remarks

The Caribbean countries of Bahamas, Barbados, Grenada, and Antigua show hardly any suicides. What can be at play here?

Apart from cultures high on extraversion and good food, a striking finding is that they only have rudimentary mental health services. Schizophrenia that is linked to drug abuse is the most prominent dysfunction, but for the rest people somehow have to make do. This begs the question: Will it be better or worse for them if sophisticated mental health systems are put in place? What do people with low mood and anxiety do over there? If you take a seriously depressed Lithuanian and place him in Antigua for two years, will he simply get better? Or, if you help people in the Baltic States to express themselves more, and to eat a greater variety of Mediterranean foods, will they get better? I know that my arguments are simple-minded, but still: if social context plays a big role in mental state, does it not make sense to address the context as well, rather than purely focus on an individual? To help individuals to understand the connection between their symptoms and the social context? If more and more young people are suffering from depression, the answer cannot simply be more therapists and more medication.

In all countries where rates are recorded, men commit suicide significantly more often than women (although women may attempt more, or as often as men), at a rate of about 3:1. In Netherlands it is the number one cause of death amongst men (more than cancer, for example), with twin peaks in youth and in those over 60. In South Africa the highest rate is amongst young white men (aged 15-24), whereas in Canada and Australia the highest incidences are amongst Aboriginal men, where it is the leading cause of death for those between 15-44 of age. In Canada the second highest rate is amongst single, divorced and widowed men in the age group 40-59. Elderly suicide rates are the highest in central-and Eastern Europe. South Korea has the highest rate in the world for children (10-19 years), and also that familiar peak for the elderly.

Youth and old age are neither spring nor golden for many people. And it is getting worse.

What to do? Let us revisit our resilient Black sisters:

Sisterhood is described as support by others, who understand your situation because they are in the same boat, and “always offer hope”.

Religious beliefs mean that that you are connected to a higher purpose,  that you have responsibilities and a place within a cultural belief-system that is esteemed and regarded by you. The destruction of traditional cultures is the destruction of whole systems rich in meaning-making,  belonging and status.

Accepting responsibility  for others means that you have significant people reliant on you, and that you accept this responsibility.

These simple answers may contain the solutions to much of what has gone missing in the lives of many: Culturally rich experiences of connectedness and identity, a wider sense of purpose, and the acceptance of a practical responsibility towards relevant others. Is this not also what is missing in the lives of the disenfranchised aboriginal peoples, of unemployed men, and urbanised youth, of those who flee into drugs or fundamentalism in an attempt to escape the void created by the dearth of meaningful real-life connections?

Hope, Meaning & Belonging

It strikes me that in the absence of religion, self–help slogans and self-help books have taken over. Written now on t-shirts and on walls, we are encouraged to “live your dream”, “not care a f**k”, and a multitude of inspirational wall quotes – the more cursive it seems the better (be the change you wish to see in the world). A string of universal slogans, strung together to prevent us from falling apart. Psychology has its own, with concepts such as “inner child” and “self-love” being offered as balsam to a suffering soul, leaving us infantilised and empty and ever-searching. There lies a conspicuous ontological difference between the post-religious decree to love thyself, as opposed to love thy neighbour. The scariest parts lie in the false promises made, “I find that when we really love and accept and approve of ourselves exactly as we are, then everything in life works out.” (Louise Hay).  No, it does not work like that. That is much too big a law, no universe could work like that. It is o.k to be flawed, not to like yourself all that much, we are all flawed. We are in it for better and for worse: that is just how it is. Best is to speak out about your grief and your loss, and your own flaws, and then to slowly build the connections out there that can create shared meaning, and authentic joy, despite our own limitations.

One of the differences between fine art and Sunday art is, that fine art points to something beyond itself, that it is not literal. Maybe it is important that we can live again with verses such as

We are the hollow men
We are the stuffed men
Leaning together
Headpiece filled with straw. Alas!
Our dried voices, when
We whisper together
Are quiet and meaningless
As wind in dry grass
Or rats’ feet over broken glass
In our dry cellar

And that it will be o.k. to do so. Because we also know that the opposite is possible:

The flood subsides, and the body, like a worn sea-shell

emerges strange and lovely,

And the little ship wings home, faltering and lapsing

on the pink flood,

and the frail soul steps out, into the house again

filling the heart with peace.

D.H. Lawrence “The Ship of Death”

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  1. The Greeting

In the beginning is relation

                      Martin Buber

 

I have always thought that way: that the relation between me and that book, or the book and the table, is still a microcosm of the relation between man and God, or God and the devil, or what have you. That the big relations and the small relations are all the same thing!                                 Gregory Bateson in the documentary on his work, An Ecology of Mind.

 

 

 

Sufficient research on childhood exists to fill an entire museum. Here is a room.

 

 

My architect friend Aubrey asks, “What are the signs of mental health in a five year old? “

“Joy in exploration, curiosity, eyes that shine”, I respond over coffee.

[1] Gordon , C. & Berk, M. The Effect of Geomagentic Storms on Suicide. South African Psychiatry Review. 2003;6:24-27

[2] January 2016: https://www.researchgate.net/publication/292762689 Activation of T helper 17 cells may contribute to neuroprogression in depression proposal of an integrative model.

[3] From the webpage www.suicide.org

[4] Puras, D., Germanavicius, A., Povilaitis, R., Veniute, M, Jasilians, D. (2004). Lithuanian mental health country profile. International Review of Psychiatry, Feb-May, 16 (1-2), 117-125.

[5] T. Kue Young, Boris Revich & Leena Soininen (2015) Suicide in circumpolar regions: an introduction and overview, International Journal of Circumpolar Health, 74:1, DOI: 10.3402/ijch.v74.27349

 

 

[6] Spates, K & Slatton, B.C. Socius (2017). I’ve Got My Family and My Faith. Black Women and the Suicide Paradox. SOCIUS: Sociological research for a Dynamic World: ASA.