Personal Thoughts of a Psychologist working with children

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: 405–412.

“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.

 

 

 

 

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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9. 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.

Do children who grow up in extreme poverty lack intelligence and imagination?

A toddler sits in the sand, eyes clouded. He simply sits. Occasionally listlessly handling a pebble. That’s it. Extreme poverty robs a child of adequate stimulation, of joyful exploration, of life-giving nutrition and care. No, poor children are not born less curious and motivated than affluent children, they become so because by the age of two their systems can already be in shutdown.

The number of first 1 000 days initiatives refer to the importance of the first two and a half years in a child’s life, when the brain forms an intricate network of neural connections – or doesn’t. Here is a quote from UNICEF  (https://www.unicef-irc.org/article/958-the-first-1000-days-of-life-the-brains-window-of-opportunity.html)

While the human brain continues to develop and change throughout life, the most rapid period of brain growth and its period of highest plasticity is in the last trimester of pregnancy and the first two years of life. The human brain at 5 months post-conception is a smooth, bi-lobed structure that looks somewhat like a coffee bean. By 9 months, i.e. term birth, it has gyri and sulci indicative of significant complexity, looking far more like the walnut-like adult brain. At birth, rapidly developing brain areas include the hippocampus and the visual and auditory cortices. In the first postnatal year, there is rapid growth of the language processing areas as well as early development of the prefrontal cortex that will control “higher processing” such as attention, inhibition, and flexibility. The first 1,000 days are characterized by rapid rates of neuronal proliferation (cell numbers), growth and differentiation (complexity), myelination, and synaptogenesis (connectivity). Thus, this time period harbors the greatest opportunity to provide optimal nutrition to ensure normal development and also the time of greatest brain vulnerability to any nutrient deficit.

The irony is that ordinary children, in ordinary homes, who have basic good nutrition, who have their questions answered, and have sufficient spaces and things (but not too many) to explore, both inside the home and outside, who hear stories read to them and have peers to engage with, will be fine. It is ironically these parents who read the research on the importance of the early years, and who then tend to expand toys and information provision to such an extent that it becomes demotivating to children (another toy-another 5 minutes distraction, another over elaborate explanation, and another loss of interest. Overstimulation an over provision lead to disillusionment, that sense of emptiness that seems to be growing in our youth. But more about this in a later blog.)

The gap between rich and poor is not only that of money and material goods. The stimulation gap is the largest of all. And in my opinion the most devastating in the long term.

My own granddaughters love animated films. They can watch them over and over again. Afterwards they play out themes from these movies with little figurines and everyday objects; princesses and ponies, witches and heroine’s, romantic hero’s and speaking animals. High heel shoes become coaches,  galloping along on their heels.

I tried to show the animated films to the granddaughter of the domestic worker who works at my house.  I had encouraged her to bring the little girl during the holidays, as she is in the same age group as my granddaughters. The little girl tried valiantly to watch,  but couldn’t. She could not make sense of what she was watching, and was relieved to go back to what she was playing with before: cooking on the little stove with pretend food and cleaning with the little broom and dustpan. This she knew, having grown up thus. I realised that children need scaffolding to access Disney, and that having watched children’s television shows such as C-Beebees and Peppa the Pig,  Thomas the Train -and my personal favourite, Shaun the Sheep – as well having listened to stories  being read about fictional characters, where dogs and chickens talk, where strange characters tell fabulous make-believe stories, these are all preparation for being seduced by The Little Mermaid and Finding Nemo.  And then making up your own version yourself.  This is why I believe that Einstein was right when he wrote that imagination is more important than intelligence. It is as much lack of imagination that is keeping people trapped in the concrete, as it is lack of “intelligence.”  Imagination requires soil with adequate nutrients to grow.

We have a farm in Namibia. A new farm worker arrives with his wife and two small children. The little girl is 4, her brother 15 months. Lucky for them, my friend who is the principal at a preschool, has joined us for the long weekend. She takes one look at the one child sitting listlessly in the sand, the other hanging idly about. “Oh NO”, she says, these children need toys. In a jiffy she has turned a plastic bottle into a type of rattle with tiny stones,  has collected an assortment of objects in a bucket for the toddler:  a scoop, my multi-coloured measuring cups,  a small jug to pour water with, a wooden spoon and a small pot to fill and to use as a drum (“I will buy you another one”) Soon she is making the little girl a doll, using stuffing from a pillow and a pillow case. She sews on eyes, nose and mouth as the little girl watches entranced. The doll gets long blue strands of woollen hair, and a dress made from dishcloth. Cleverly my friend then makes her a little bag that she can carry the doll in. She demonstrates to the boy how to play. He had NO idea. No networks stimulated into firing, no networks growing into other networks.  The little girl gesticulates to my friend to change the bag so that the ‘baby’ could sit on her back. “See”, my friends says delightedly, “she is beginning to think, to plan!”.  And to imagine.

Children in poor environments need “pretend” from an early age as much as they need nutrition. It starts with a plastic duck in a bath tub, a chink of driftwood flying “zjoo0” as an aeroplane, and expands with increasingly multi-layered exposures. This fires up children’s neural systems, creating multiple pathways.

I am in the Cape Town Waterfront. The bridge connecting two sections is lifting to allow  a boat through into the dry docks. As I watch, I notice a young father, holding his young boy of about three years old on his arm. He is pointing towards the bridge and talking to his son. He seems to be carefully explaining what is happening. Both are engrossed in the magic of the moment. And then I spot the other father. He has son of roughly the same age, standing next to him. Both are watching. None are speaking. No explanation, no connection.  A different part of town, a different experience. I wish I could have made a video.

If poor baby’s and toddlers lived in the same environments as non-poor babies, if they received similar stimulation from the start, we would not have this gap. Toddlers, given half an opportunity, instinctively respond. They will crawl eagerly to explore, eyes shining.. (Whilst houseworkers, overstressed poor mothers and authoritarian parents try to put a stop to it . . the pulling out of pots and pans too disruptive, too noisy, too untidy, too risky.  This is where television as a babysitter becomes a real threat to a child’s development),

We know that the educational level of mothers is a crucial determinant of the educational futures of their children. From experience I would add that working class mothers are often overburdened and under-supported, especially by the fathers of their children.  It is hard for a mother who has anxieties about day-to-day survival to engage spontaneously with a child.

I end off with an extract from The Institute of Family Studies:    (https://ifstudies.org/blog/the-many-ways-mothers-education-matters)

The concept of human capital is easiest to understand. Essentially, it refers to individuals’ knowledge, skills, and abilities, which they develop primarily through education and “capitalize” on in the workforce. In the realm of parenting, a college degree (or the knowledge and skills it stands for) seems to make people interact with their kids differently. Take the famous thirty-million word gap, for example: some scholars estimate that children of parents on welfare hear 30 million fewer words by the age of four than the children of professional parents.

The gap is not only about quantity, but quality: Better educated parents also use a wider vocabulary, and they dole out affirmations (not just complimenting kids, but repeating and building on what they say) more generously than less educated parents. Learning lots of words early in life is tied to better academic outcomes down the road, so parents’ early conversations with kids have long-lasting implications.

Mothers’ education also matters later in childhood: College-educated mothers are able to more appropriately tailor cognitively stimulating activities to their children’s developmental level , and they are more equipped to help kids do homework and study for tests.

 

 

 

 

 

 

 

Meaning making and emotion regulation

“Seeing ourselves form the outside and others from the inside”.

How do we make sense of our own feelings and the behaviours of others? How do we learn to soothe others and ourselves? Our understanding of an event and our capacity to deal with it are two sides of the same coin. Adjust your understanding, and you will react differently. Much personal distress and relational difficulties are the result of painful meaning-making.

Through the experiences that we had of being understood and being soothed in our earliest care-giving relationships, we learn to mentalize (to have in mind, to make meaning of) our own reactions as well as those of others. The ways in which we experienced this “having in mind”, will comfort us, or scare us, or make us anxious, or make us want to run away from it. How we respond today is very much imbedded in the early reactions of our caregivers.

A simple, common  example is parents who become highly upset when a child is upset. This soon sets a pattern of becoming highly upset when you are upset (and often, blaming the other).  Another example, frequently observed, concern adults who scold and blame children for doing what all children do naturally: jump into puddles, get dirty, squirm in their seats, make a mess, and shout out of sheer joy. The stressed adult is unable to access the childhood mind, berating the child for not acting like an adult.

Anyway, children so readily accept the blame for being in the wrong, parents are easily vindicated, or so they think at that moment. Unfortunately these children tend to become increasingly naughty – the exact opposite of what the parent desires. In time the children themselves begin to shout and blame – and land in trouble at school, from where they are referred to people like me to “be fixed.”

It is important to understand that the ability to name and to manage emotions (or not) is learnt (this is therefore the bedrock of some therapies). If your parents had seldom experienced themselves being understood, and rarely had their experiences reflected to them by caring others, they will not find it easy to pass these capacities on to their children. If we are not kept in mind, if we are not related to as a person with an intentional mind, then we will find it hard to keep some rational, thinking mind and to self-regulate when we ourselves are in distress, or when we have to soothe another.

Sometimes an adult can upscale so alarmingly, that a child adapts by downscaling their own emotions, becoming “sweet” and  “good as gold.”. Or parental.

The world of feelings can threaten to overwhelm us. We then do not really want to listen when another becomes emotional, because it evokes unmanageable feelings in us.

How to restore balance

When a parent says to a baby, “Hey, I am sorry that I am irritated with you. It is not your fault. I am worried about work, and now I take it out on you; you are just a baby”, the baby gets to understand that feelings have reasons – even if they are sometimes unreasonable. The child learns that the emotional world, and its problems, has its own meanings, even if they do sometimes spill over – and that these can exist separately from the self. Combined with humour and compassion, powerful tools of distress management are thus being developed, as humans learn that people have separate minds and can use meaning making as tools to use when they need to cope with our own problems and the difficult behaviours of others.

Adults, who were not sufficiently kept in mind as children, fail to keep others in mind as separate, meaningful beings. They tend to interpret events negatively, and fail to consider how their lives influence others, and often show no real compassion for the other, except maybe when they think of the other as like themselves.

This is not only a personal development; whole societies can act like this. Having your mind in my mind has as much to do with how we think of others, as about ourselves. It plays itself out when we meet people who are different from us, and wherever we find expressions of power. Much better to be aware of it than to be unconscious of it, where it can become a power of destruction.

Emotional dysregulation is inherent in all sustained distress and harmful behaviours. It is the bedrock of fractious relationships. Being in distress after an upsetting event is normal. Not being able to recover from your distress months, even years later, is not. Responding with focused anger to a real threat is healthy, raging at imagined threats, is not. Love and elation are wonderful feelings, but not when they become obsessive, and lead to destructive decisions. In learning how to regulate our emotions, first it is our family members who instil our habits, later it is our peers, and then the cultures that we live in sanction and shape our responses.

To be able to express your own emotions, and to be able interpret the emotions of others, both the negative and the positive, in ways that lead to the restoration of harmony and joy, this is a life-long challenge, seldom perfected, but always worthwhile to pursue.

Having your mind in my mind

A little girl of six, two neat brown plaits standing away from her head is brought to my practice because of her bed-wetting. Her mother is having an affair. The parents are whispering behind their bedroom door, clearly in distress. When the little girl asks about this, they reply that she should not worry, this is a grown-up problem, and they will sort it out. The little girl continues to worry. I understand her bed-wetting to be her inability to cope with the tension that lives behind the closed bedroom door.

“Little girls worry when their parents argue behind closed doors, “ I say.

“Yes”, she replies. “But what does it mean? Does it mean murder?”

The capacity to see things from the child’s perspective is an essential ingredient of sensitivity[1]. This means that the child can be safely held in the parent’s mind. For a child to experience ‘thinking about’ as a safe and inherently useful experience, the parent has to sufficiently often name the child’s experience appropriately without criticism or judgment; just accepting and naming the child’s mind, as it is. Parents who react in ways that a child cannot make sense of, or cannot have in mind, or are unsuited to the child’s developmental stage, creates unknown anxiety and an avoidance to keep things in mind. In extreme cases, a state of “mindlessness” is created.

A few years ago I visited a woman who worked in our house when I was a child. I was curious about why I had felt so safe and free with her, and had cried such bitter tears when she left. We were having tea in her lounge, when her granddaughter, aged about six, and whom she looks after during the day, was called in from outside where she had been playing with others. She stood at the entrance to the door of the lounge, sulking. “What is the matter?” asked her grandmother, with a note of slight concern in her voice. Then promptly remarked, “Oh you are upset because you have to come in already.” The little girl’s posture relaxed (grandmother was right, and had read her mind correctly, and accepted this without fuss, and without blame or the need for a sermon). “Come”, said her grandmother in a soothing voice, “let me fetch you a yoghurt, and then I will tell you who this lady is who is having tea with us.” They left for the kitchen, hand in hand. When they returned the granddaughter joined us, sitting on the carpet, closer to me now, eating her yoghurt, curious about the stranger.

I understood that this woman has the wonderful ability to see a child, and to care about what she sees, and to name what she sees in such a manner that it contains the child, and to take ordinary practical steps to ‘make things better’.

The little girl in the first example, the one whose parents were experiencing problems, has parents who love her, and who care about her. But they did not feel safe to name her fears. Unnamed they lived inside her. She tried to make meaning by thinking of the worst thing she could think of – did they commit an act of murder? Would this mean they would have to go to jail? What would happen to her? Not coping, she wets her bed.

[1] Research on Maternal sensitivity shows that all mothers, independent of culture or context, tend to respond in similar sensitive or insensitive ways, which can be precisely defined. Simply look up the term, which was coined by Mary Ainsworth. Jon Allen of the Menninger Clinic has open resources on the lifelong impact of Mentalizing, mentioned above.

Where there is a will there is thé way

What is will? A person’s choice or desire in a particular situation. Merrriam-Webster

Free will?

 Within your will you experience yourself. This is already noticeable in a two-year old: The experience of an injury to the will as an injury to the self. The two-year old is taking on a momentous battle with the desire of its family to shape this child to their own expectations, to the cultural pressures bearing down on the family, and the Zeitgeist that envelops all. A Freudian battle ensues between id, an immature ego and the superego, would be one way of putting it. [1]The most effective parents have impressive skills of sublimation and redirection, shaping the child’s will gently yet firmly, but without the threat of annihilation of the child’s will and therefore nascent identity – or even worse, distortion of the child’s expression. The former usually leads to rebellion and/or depression, the latter to mental illness.

A tired child is an irritable child. We all know that. “What do you want?” asks an exasperated parent.

To give a tired child a hiding for being irritable means to confuse tiredness with ‘being naughty’. When enough of these experiences add up, the child begins to confuse his (or her) own inner signals, and in time, those of others. Thus happens distortion – or what is known as ‘a lack of emotional intelligence’.

Attachment research is based on thousands of hours of observation of the interactions between infants and toddlers and their caregivers, all coded from video. One of the findings refers to the tendency of a caregiver to follow a child. The colour of this one simple skill provides us with a peephole into the world of humanity. If frustration and anger are brothers, then being followed is the magic wand that evokes harmony.

Following (Harmony vs. Irritation)

A baby and an adult are cooing, faces close together. The mother is mimicking the infant. Suddenly the infant stops, turning its face slightly away. Mother stops, is quiet, watching baby. This is a mother who intuitively ‘gets’ that the infant is taking a break, is regulating the interaction. The baby turns its face back, and the interaction continues. A response like this is natural, and occurs independent of culture or socio-economic class. Mothers in shantytowns do this as often as mothers in upmarket apartments. A different mother interferes, tickling baby’s face to get its attention back. Baby becomes restless, squirming. This is also natural human behaviour, occurring everywhere. The outcome for baby and mother is O.K., but here will be a tenser baby and a tenser mother. Largely consistent early experiences of sensitive flow or curt interruptions create different patterns of being. Bath times and play times provide everyday examples of allowing a child to set their own pace, or not. This is also at the root of the development of self-regulation. Stopping or interfering with a child’s normal inclinations for exploration and play on a regular basis, is one way of undermining self-regulation as well as inner motivation. If you had sufficient experiences of being in flow as a child, this becomes part of your body memory. This memory is something that you can tap into at times of distress as an adult; inner experiences of being in harmony and of the world being a good place, and so the people in it.

Interruption is the opposite of flow. I have often wondered if some children with ADHD have not been constantly interrupted since they were babies to such an extent that the neurological substrates for focused attention never had sufficient opportunities to develop.

Intrusive and critical parenting: The opposite of smooth, flowing interactions are interruptive, intrusive and critical interactions. This is one clear link that has been replicated: the link between severe psychological difficulties in adulthood and having experienced intrusive, critical parenting as a child.

Intrusion has become pervasive

The loss of the large extended family and safe communal neighbourhoods has resulted in near constant adult supervision with much less freedom for children. Over-involvement has become the norm in many families. This has also lead to the over-psychologisation of childhood. The will of the parents and the will of the child are becoming one thing; a claustrophobic enmeshment that well-intentioned parents try to solve by increasing their engagement.

And then there is the general lack of quiet and of space.

Two sides of a coin

I watch as a father opposes the will of a son, who looks about seven years old.

We are on the beach, and the son has put out a sandy hand towards the apple on offer.

“Go and wash the sand of your hands first”, barks the father.

“It’s ok, I will eat it like this”, responds his hapless son (Does he not know by now?)

“YOU WILL GO AND WASH YOUR HANDS FIRST. OTHERWISE THERE WILL BE NO FRUIT FOR YOU.

Why oh why is the human so stupid? Can he not see that he is stoking a rebellion?

The other side of the coin

The meme of “choice” that is en vogue with many aspirational parents, combines free will with immature power – a well-meant, but unfortunate combination that results in exhaustion, frustration and despair. In a local grocery shop my ears pick up a conversation between a couple standing in the aisle with frozen goods. The man makes a food suggestion, and the woman responds with a worried look, ” I don’t know if she will eat it.” She is about 18 months old,  sitting in the shopping-trolley looking smug and tense, as mother holds up two boxes with frozen products, ” Would you like this?” Mother’s voice is pleading and anxious. The meme of choices gone wrong, wreaking its havoc on this family.

When I started out my practice in 1990, the most common referrals by parents were bed-wetting (usually a symptom of a child not coping with what could be a difficulty within a wide range from learning difficulties to parental enmeshment or discord to abuse), anger (read frustration) or lack of motivation (often related to insufficient autonomy granting).   In the years between 1990 and 2004, I had two referrals of a parent not coping with a two and half year old. In the past three years a parent not coping with a pre-schooler is a weekly occurrence. At the core: An imbalance of power. A young child who has been given too much power, clings to it like an addiction, and develops an immature form of it, a type of pseudo maturity, which causes unrest and stress, not only in the child, it fans out into the family and the school. A child with too much power too early, is an unhappy child, who can own all there is to own, but craves more because the hole in the middle where security is supposed to be (adults are in charge and all is well), is uneasy. This is also an ironical consequence of the practice of “giving choices” in the belief of empowering children. “Do you want the yellow plate or the blue plate?” Do you want to wear the t-shirt with the truck or the puppy?” Soon a child comes to believe that these things really matter. That is of great consequence. So that when the child demands the yellow plate and it is in the dishwasher, parents look at each other: Calamity! These beliefs tend to grow tentacles, so that children can become potentially unhappy about a myriad of truly inconsequential things, with the potential for unhappiness residing in a multitude of what should have been smooth interactions. A world in which a young child is in charge is a scary world that the child tries to control by exerting childish control over childish things.

Power is addictive, even a toddler feels that. Power over food – a primary survival need – is enormous. Our children are increasingly robbed of spaciousness, freedom and security, ironically also by the imposition of too much power, too soon.

As I watch adults giving tiny children power over their diets, I have to suppress sarcasm, and a sense of powerless despair rising in me: What do they expect their children to base their food choices on, knowledge of nutrition? What used to be named Adult-onset Diabetes is increasingly diagnosed in children under the age of nine. Is nutrition not supposed to be a non-negotiable adult terrain, like not running into the street and never putting your finger into a power socket? At the World Association for Infant Mental Health conference in Leipzig in 2010, I noticed for the first time a separate category for “Eating Disorders”. (Infant mental health is for 0-3 years). I watch surreptitiously as slinky mothers order grilled free-range chicken for themselves, and pizzas with processed ham and cheese for their children.

When adults are not in charge, a childish power surges through demanding instant gratification, unhappiness spreading through families like marmite on their daily bread.

Am I advocating the return of authoritarianism? No, just sanity.

To honour the will of a child

Autonomy

“Self” “

“I want to do it myself”

“Me did it!”

Achievement. Satisfaction. Pride.

Personal accomplishments are the bedrock of satisfaction. Joy. Peace in old age.

A child will express its own will naturally through play, and in the small choices that they make spontaneously. The child who wanted to eat the apple with a sandy hand was saying, “It is ok with me this way.”

“Put your books in the bottom shelf.”

“But I want them in the middle one.”

This is not a threat to your authority. It is a simple expression of choice that can easily be honoured.

Children will spontaneously play “house”. They will play out good and bad, will mimic funerals and festivals, will have pretend guns and babies, wear funny clothes, be happy on their own in no longer warm baths, splash clean clothes in muddy puddles, attempt things on their own impulse. All we need to do is to let them be.

Self-regulation and the Internet

Whole books are written on the topic of self-regulation. Many regard it as thé mental health topic of our time, with both children and adults struggling equally. To add a penny’s worth: We are living in fluid times. Solidity is increasingly found in fundamentalism. What to do when life becomes one big uncertainty? When stress is pervasive?

A new generation is on the uprise. This is the generation that has two identities: one in the here-and-now and one online. There they have families, friends and enemies, they have an alter ego, a whole persona with a different personality, wearing different clothes and a different set of skills. Why not rather live there? Over there life is far more in control, it is more predictable, possibly more exciting, and certainly more soothing than life out here. The World Wide Web has become a soother, an escape route, of note.

Our will tells us that we have the potential to make a free choice, to be. To will is to be. Without some will you won’t be able to get up in the morning. Can it be that a will is one of the central forces of being alive?

Will and Dignity: Is a person without a will not a person without dignity? Is the fight for our will to be done, not also a fight for our own dignity? Is forcing our own will onto others not a denial of their dignity? So that we have an interconnection of will and dignity and power; a web of liveliness or a web of destruction.

“But what do you want’? Many have asked this in despair. “I don’t know”. “ I am not sure”.

So many injuries from willing wrongly. And from others willing you wrongly.

Yet the persons who walk into my room are quite sure of what they want: To be better. To be cured. Not to be so anxious. To have a relationship saved. Not to be so sad. This is a will in which they have faltered, despite their best efforts, and often also the efforts of those around them. This is the most plausible reason why help is sought. They walk in with their shame and despair at having failed at their own will for their lives to be different.

What is depression and grief but an injury to will. To become separated from your own will. What is anxiety but an attempt to control a potential threat to your will. Willpower is a neglected term in Psychology (we prefer softer terms such as motivation and resilience), but without a will to power, how would you make your way in a world that is inevitably an obstacle course over different terrains, how will you stand your own ground, and how will you feel truly alive? Will, ambition and positive self-pride are intricately connected: As the song about love and marriage goes, “You can’t have one without the other.” And as there can exist no perfect kind of willpower (as in the story of the three little bears: too small, too soft, too hard), what would be “just right”? I don’t claim to have the answer. I can venture that if you look into your own life, you can take your own measure.

Will, as you can gather, is a tricky bugger. Who knows what the will is of someone with severe despair or anorexia or hypochondria or addiction – to die or to live? We have to find the will to create. To be.

People often say that this or that person has not yet found himself. But the self is not something one finds, it is something one creates.                  Thomas Szasz, Psychiatrist

 

 

  

[1] id refers to our natural instincts or drives, they are often unconscious, ego is the “I”, the self that is known, whom we will conceive ourselves to be (we also have an ego-ideal). Superego refers to the development of conscience; the internalization of moral standards.

Some days I think we have all gone missing in this overkill of information and options. To use nutrition as a metaphor: if we all just ate three meals of real food every day, would that not quite simply suffice and liberate us all from the plethora of debates? So as for “Mental Health”: Speak out, speak up, work constructively, play constructively, build  constructive relationships,  and be spiritual in some way… (oops that was what Freud and Jung also said)…