Presenting Symptoms

When an individual comes in for the first appointment, he or she usually has some specific difficulty for which they are seeking help such as a morbid fear of Toyotas. Their reason for consulting me is called the presenting symptom; however this is often not the real problem. Sometimes the problem is unconscious in origin, but sometimes it is not repressed and thus easier to uncover, that is, if I'm paying close attention and asking the right questions.

The couple I mentioned previously in "The Sadomasochism Tango" came in again this week. All in all they are doing quite well. In passing the wife mentioned that she'd had a doctor's appointment this week. It seems that many years ago she was diagnosed breast cancer. There was recurrence a year later and then several more lumps which turned out to be cysts. During this time she was in treatment for her cancer, the two of them hardly mentioned their fears for the future. Each bottled up their emotions and suffered in silence. As they talked I'm mentally calculating that the husband's drinking became problematic about the time of the cancer siege. This week's appointment was to see her family doctor to check out a new lump. She is scheduled to see the surgeon next week, but her doctor is 90% sure it's another cyst. Suddenly everything made sense to me. I asked when she first noticed the new lump. She told me the date. It was the next day she called to make an appointment with me asking for help with her husband's drinking. His drinking appears to be his coping mechanism to handle his fears about his wife. And it also serves to effectively divert his wife's anxiety on to him. The "problem" is no longer her cancer, but his boozing. Aren't people complex?

Another man came in recently after having a truly horrible fight with his wife. He's wondering if their marriage can be saved. He's so miserable that he's not sure it's worth trying any longer. He mentions casually that he thought the last time he and his wife had a fight like this was a year ago, just about this time of year. We did a little checking and found out that they'd had a baby die..wanna guess when?....in late October. Training analyst says it takes on the average eight years before a couple can talk about the death of a child. It has been four years for them. The rage they feel, they direct at one another and for the guilt they each feel, they seek punishment. The fight had to do with unresolved grief no matter what else they might have thought it was about.

Mommy programming

I had the funniest mental blip the other day. As I entered my mother's hospital room, I found myself thinking "I wonder if she'll think I look nice today?" Here I am, a mostly mature adult in my late 50's, a wife, a mother, a professional woman hoping my mommy, my half-blind dear old addled-brained mommy, thinks I look pretty. When I realized what I was thinking, I told myself that I didn't need my mother's approval to feel ok about my appearance. I happened to think I looked rather spiffy that day. Even so, I found myself pleased when she did compliment my appearance that day. Isn't that strange that we, correction I, still want good old mommy to pat my head and smile approvingly over what I say and do?

When Mother was readmitted to the hospital, I firmly resolved that there would be no more assisted living for her and the next move would be into a nursing home. As the days passed, I expected she'd start talking about going back to her apartment but she didn't. I went ahead and made arrangements to reserve her a room in the long term care unit and also to clear her stuff out of her apartment, but I didn't discuss any of this with her until today. She accused me of sneaking around behind her back. I played my trump card which was this was what her doctor recommended. That made her think for a moment, but she kept saying she was totally surprised even though minutes before she was saying she doubted she'd ever leave there. My little girl thinking came rushing to the forefront with its second guessing, its wondering whether mommy was mad or mommy was happy with what I had done. She seemed pleased when we showed her the new room. It is just down the hall from her current one, but once more she said I'd been doing all the planning behind her back. She's right. The mature me knows that this transition would likely cause some protest. Who would want to go to a nursing home if given the choice? I guess that's the rub: there is no choice. I made it and no matter how I sugar coat it, it is a lousy thing to have to do to your mommy.

Fleshly delights

Oh, boy! A most delicious odor is wafting in from my kitchen. I have dedicated this afternoon to making up two trays of lasagna, one to eat tonight and the other to freeze. The days of my herb garden are numbered so I thought it best to dump into the sauce large amounts of the remaining parsley, rosemary, basil and oregano. I'm not experienced in herb cultivation but it seems that the rosemary has gotten much stronger as it has matured. But the smell of fresh cut herbs is positively wondrous and the taste samples of the simmering tomato sauce are even wondrouser.

The lasagna recipe I use is an approximation of my mother's which I have tweaked over the years, most notably by using 2 parts Italian sausage to 1 part ground beef. If my daughters use this recipe, no doubt they will add their unique signature touches.

My book of the week is Miroslav Volf's Free of Charge: Giving and Forgiving in a Culture Stripped of Grace. A culture stripped of grace....what a great phrase! He is one of those people whose love of life is positively infectious and I find my heart warmed by his generous spirit.

I have three way tie for CD of the week. First is Tony Bennett's Duets: An American Classic in which Tony and selected friends sing a wide variety of pop standards. My favorite number is Tony and Elvis Costello doing "Are You Havin' Any Fun?" which is just a rollicking performance accompanied by a big fat lush orchestra. My second CD of the week is These Days, a 4 disc set by Vince Gill who has got to be one of the most versatile performers out there. I have downloaded several songs. My favorite is "Some Things Never Get Old" with Emmylou Harris singing harmony. And if this isn't enough good music, I have recently discovered a very talented young Brit by the name of Jamie Cullum who has a great pop voice and plays a mean piano. OK, I know he may be old hat to my hipper more musically cognisant relations, but he's a delightful find and uses first class jazzy back up instrumentalists.

The Ugly Duckling

USA Today ran an article about 101 most influential fictional characters this past week. Of course part of the fun of reading such lists is disagreeing with the compiler. Fairy tales once again got a bad rap. These stories are not the psychically damaging, anachronistic, patriarchal propaganda that some parents groups believe. They are how children over many ages have been able to safely discharge their forbidden inner aggressive and sexual impulses. Children love fairy tales, the more violent the better. They love it when Handsel and Gretel shove that mean old witch in the oven. They love it when the wolf eats Grandma and when Jack outwits the giant and steals the goose that lays golden eggs. Experienced Moms and Dads know full well how small children beg to hear these stories over and over and over again.

The list authors state that The Ugly Duckling insults 90% of the population because it emphasizes beauty. Boy, do they have that wrong! In my office, I have multiple copies of that story including the original version, a little kid simplified version and gorgeous Caldecott award edition which I hand out to patients to read. Adults and children love the story because it helps them see their long-standing sense of alienation, of not fitting in or of not belonging in an entirely different light. The adult who walks into my office is usually the pick of the litter, the best one of a disturbed family system. It's the problem solver of the family who seeks help. I've had competent, capable, accomplished people sob because their family members routinely run them down when they excel and ascribe to them selfish motives for very kind acts. One woman was deeply hurt because her mother called her the ugly duckling of the family. The woman didn't know the story. She thought her mom was once again reminding her, as if she didn't already know, that she was not as pretty as her sister. I sent her home with two versions of the book. She needed to know the end of the story.

I also read this story to little kids who have been removed from bad homes or have been adopted to help them understand that the problem is not them but the owners of the nest into which they were born. I will read this to very bright children who have been born into an average family. Such kids are routinely misunderstood by the adults in their lives and not infrequently think they are stupid or have dumbed themselves down to fit into their world. The Ugly Duckling tells kids that is you won't always be living with this bunch of birds you are living with now and it is possible to find similar birds to hang with when you leave the nest.

Shameless Plug

This is a blatantly shameless plug for one of my favorite charities which is The International Rescue Committee.

The IRC can be found in the hardest, most miserable and remote places on earth helping with basic needs of people displaced by famine, natural disasters and political disasters. In checking Give.org, 90% of the monies the IRC raises go to directly to their programs. Their are no cute red phones, cool white bracelets, or pink ribbons to con you into giving. It's just people with more than they need sharing with those who have nothing.

That said, I've been enjoying the calm after the chaos of last week. I'm finally sleeping well and restoratively. The decorating boys are back this week. They are tackling the master bathroom. Once the painting is done, I have the tough job of selecting new towels, rugs and curtains. I wish I were better at decorating. I kind of guess using the WWPBD(what would Pottery Barn do) approach. Next we will be hiring a carpenter to build us a new ramp up to the front door. Yes, brother-in-law will use it but it's been handy for the dog these past few days. Our dedicated slug decided, in an impulsive burst of energy, to chase after three deer who were munching on our magnolia tree early Sunday morning. Fifteen minutes later he limped back unable to put any weight on his right hind leg. I doubt highly he got anywhere near Bambi and friends but he must have twisted something in trying. He's healing slowly. The hubster, at first, made some noises about putting him in a cast, the thought of which amused me greatly. So far, the dog is getting lots of pats and attention due to his crippled status and also because he's been tied up while the painters are here.

Family doings and undoings

I have a way of thinking that family functions will be a lot worse than they normally are. I worked late on Saturday and came home totally spent. I think last weekend's siege with my mother was finally catching up with me. The last thing I wanted to do was go to a family party where I'd have to summon up enough energy to be somewhat sociable. The occasion was my brother-in-law's 60th birthday. The nieces and nephews would be there which is usually fun. They are neat young adults although I am beginning to see the seriousness and stodginess of adulthood taking shape in them. Dang, they are acting more and more like their parents!

Actually it turned out to be a lovely occasion. There were superb steaks and homemade cheesecake. This cheesecake was the specialty of my husband's late aunt. My sister-in-law has since become the guardian of her cheesecake recipe. She has the process down to perfection. I ducked out when the party headed outside to carve pumpkins, though not before there was a maiden voyage of the birthday boy's new Loch Ness monster in his pond. I can't imagine who would think to give him such a silly toy! It was a big hit with oldest niece's dog.

I hadn't visited my mother yet that day, so I headed off to the hospital. I found Mother pretty fuzzy and uncomfortable. Her pain pills were due shortly so I didn't fret much. She was happy(and she remembered) that my sister had called that afternoon. Tomorrow I call the moving company and begin in earnest the process of moving her stuff out of her assisted living apartment and into storage. I will have to sort through her belongings so I know what to take with me for safekeeping and what she might enjoy in her nursing wing room...like some photographs and her brightly colored bedspread. The phone service needs to be stopped and change of address notifications need to be done as well. Not much fun any way you look at it.

The Sadomasochism Tango

I met with a new couple for the first time last night. They've been married 27 years and for most of that time, his drinking has been a problem. He drinks, she gets mad. He drinks and lies about it, she gets madder still. There is a blow up she pulls out all the stupid hurtful things he's ever done and he feels like the world's biggest loser. She simmers and sulks. He gets drunk. And on it goes. They perform a well-established dance, the sadomasochistic tango. One psychiatrist stated that when you treat such a couple, you are in fact treating four people because they take turns as sadist and as masochist. I'm not sure yet why she needs to be punished. She almost growled when she said "I don't believe in divorce." No one in the room had brought up divorce!

But she gets to punish him all the time for being such a bad boy. My antennae went up when I found out that he'd been a Roman Catholic altar boy as had his two brothers. They are also drunks. He denied anything inappropriate happened with a priest or seminarian, but I still leave this open as a possibility. It would certainly explain the booze. There is something called repression and drinking suppresses dreaming. And dreamland is where those repressed memories are alive and well. I can't jump to conclusions after just one hour. As my training analyst says "Go for history, history and more history". And so I shall.

Careful little parameters

I had to laugh when re-reading yesterday's post. I now see my thinly disguised rage at the hospital system dripping psychological name calling and topped with sugary nice words. I guess I can be forgiven for some anger.

Meanwhile, I just finished "Leaving Church" by Barbara Brown Taylor. Since I left church almost two years ago, after many many years of dutiful attendance followed by many more as a "pillar" of the church, I was curious to read her story. She writes beautifully-at times achingly so. Her story is not mine. Her reasons for leaving church are not mine either, but there are familiar stories of too much frenetic church activity and too many demands for one human to endure. Later she speaks eloquently about seeing God at work outside the safe walls of the church.

Many years ago, I described myself as living within careful little parameters. Little by little, I found them to be flimsy cardboard parameters which I could knock down or step over with ease. But before they fell, they gave the illusion of being huge, permanent and insurmountable. Over time, the parameters which had both defined me and restricted me have been systematically demolished.

The institutional church for me was the last careful little parameter to fall. I have traveled from denomination to denomination and each one sooner or later became another prison to me. Although I am thankful for what I learned from each faith community, ultimately I learned the same thing: "you don't belong here". And I would move on. When I left the last church, it was very hard because I knew I would not be going to the warm welcome of another church home. I would be homeless and live on the edge of the map as Barbara Brown Taylor describes this place. The surprising thing has been my faith is still strong, although at times I sorely miss having a faith family and a faith identity. But that lack of identity removes a potential barrier between me and my patients. I am less of a threat to anyone who has been badly hurt by religion, to the non-Christian or to the unbeliever. I am also familiar with the parlance of many Christian traditions. For example, I can use a Catholic frame of reference to teach a former nun or a conservative Christian one to treat a Southern Baptist. The institution of the church formed me from birth. I am who I am, in great part, because of it. But the warnings Jesus gave to the religious folks of his time are still pertinent today and I've learned that The Way does not always stay with the careful little parameters of the institutional church.

Tuckered out...

I thought I might take a break from writing gloomy posts but this weekend topped it all. One thing for certain, I am exceedingly glad I never went into medicine after spending the better part of two days at the hospital. Methinks a reaction formation may lead many to chose this field. In others a repetition compulsion may be operational, like the woman who becomes an emergency room physician after the sudden death of her brother from cardiac failure. Regardless, I bless the men and women who do work in hospitals and am grateful to those who do their work not only well but with gentleness, good humor and kindness. But I digress....

My dear mother performed a revolving door routine on Saturday when she fell in her assisted living apartment not 8 hours after she was released from the hospital. Miraculously she did not break any bones but we are back to square one. She is currently on the medical floor, very sore and quite confused. She'll get moved up to third floor within a few days. The powers that be will decide whether she goes immediately to extended care (their name for the nursing home wing) or to transitional care for more rehab.

I awoke this morning afraid I might be getting sick but I think my body is just achy from tension and fatigue. I found myself thinking about the stupidest things in the middle of the night like whether it would hurt her partial to leave it in denture cleaner overnight. Now I've learned that when my mind obsesses over silly stuff, particularly something I can't do anything about at 1 am (as if I'm going to run out to the hospital to save her partial from certain death by Polident), that the real anxiety is my dread of her death and that somehow it would be my fault. Those fears are displaced and become a long mental litany of "what-ifs" followed by my famous toilet training based game of second guessing of myself: did I make a mistake or am I doing it right?

However I did find that a nap in the hammock this afternoon proved very beneficial. The current crisis has past so now it's time to rest and regroup. Why, I can think about the implications of North Korea's bomb or better yet listen to my CD of the week Amos Lee's "Supply and Demand". Yeah, I like the second option a lot better.
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Amnesia and dancing

Tomorrow, good Lord willing, my mother will be discharged from the hospital and will return to her assisted living home. And to think six weeks ago I was planning what to wear to her funeral. Not long ago I told her that I thought she was dying when she entered the hospital. She was totally astonished. I said that was why her other two children came to see her. She didn't remember their visit or much of anything since the middle of August. Wow! All those hours spent at her bedside, the effort, time and money expended by my siblings to get here, the raw emotion, the fitful sleep, and gratefully, the severe pain, she didn't remember any of it. We've survived a tough battle and she doesn't even know it. Time will tell how much of her amnesia is the result of dementia and how much was due to the severity of her medical crisis. Yes, I'm totally aware of my own little narcissistic need for a pat on the head from my mommy who then tells me what a good girl I've been! But my mommy, dang it, can't remember any of it! Sigh!

Yesterday, Mother's 97 year old roommate was being visited by two tiny great-grandchildren. The youngest was Kaitlyn who spontaneously began singing to herself while the adults were talking. She was perhaps 18 months old. Her songs had no words but they were so enchanting, that conversation stopped as we delighted in her singing. It was pure unadulterated joy! Then she wiggled down off of her grandmother's lap and began to dance. She danced to her own rhythm as we clapped along with her. I thought of my own youngest who sang before she could talk and was nicknamed boogy-baby because she too, would dance just because dancing made her happy and maybe because dancing was a lot more fun than walking. Thank you Kaitlyn!

Happier thoughts

National headlines have been so unbelievably gruesome and shocking this past week as everyone, who has not been in a coma, knows. I started writing yesterday and stopped because I was glooming myself out! I get way too cynical and pessimistic. It doesn't help anyone to play the "ain't-it-awful" game. So I turn to less disturbing topics....

-My oldest daughter is planning a trip to a camel dairy.
-I brought home a big fat mum and some Indian corn to decorate the newly power-washed and weather-proofed front porch.
-My youngest is coming home for Thanksgiving.
-My youngest is coming home for Christmas with her fellow.
-My mother had her third epidural yesterday and is making a splendid recovery.
-Son has a new girlfriend who does not appear to be a flake.
-In my on-line trivia game I placed second for the entire month of September.
-In my on-line trivia game, I am in the hall of fame. It may be the only hall of fame I ever achieve, but I'm a gen-u-ine hall of famer now.
-I believe I have figured out what is behind the very strange "panic attack" that sent a young woman to the emergency room a few weeks ago and led to her seek my help. If I am correct, this will be a case I should write up for a journal.
-I have been enjoying some fabulous music performed by the Dale Warland singers on their "Harvest Home" CD. Listen to the clip of Beautiful River to give you an idea.

And that, say I, is that.

Holding on

I having been thinking a lot about the difficulty some people have in letting go of the past. It may be an old girlfriend or boyfriend that dumped them or the ex-husband or wife from hell. Others obsess about some wrong done against them or some sin they committed. Stolen family fortunes, broken promises, affairs, abuse,betrayals and unfulfilled dreams overshadow and contaminate the present. It's as if there can be no happiness, no satisfaction in life, and no future because of whatever it is in the past that they cannot leave behind.

These people typically are what psychoanalysts call an anal character i.e. one who hangs on to stuff, can't let go and fears making mistakes. And any mistakes get blown out of proportion as if they were life and death matters rather than very human errors. Anal characters tends to hold grudges and thus find it hard to forgive themselves or others. They are still valiantly fighting the toilet training battle crying out for all the world to hear "You can't make me do it!"

One woman bitterly blames her ex-husband for everything wrong in her life. They've been divorced ten years! And they were separated many years prior to that. There is no doubt he was a jerk, but ten years later she's still hanging on to her anger. I found myself thinking that this gal is having a sit down strike. She recently lost her job and now she won't exercise, eat correctly, look seriously for a job, keep her apartment clean or do much of anything. Loss=loss. The loss of her job pings every one of the previous losses in her life...like dominoes tumbling all the way back to her early childhood when her mom, perhaps too harshly, too early and too abruptly demanded she mature and use the potty. So now, when she's mad and when she faces one of life's inevitable set-backs, she goes on strike. She sits down like an angry toddler. She hides out hoping that no one sees what a mess she's made. The key is to help her improve her life now. If the present is better and there's hope that the future will be even neater, then she doesn't have to hang on to the past. Gradually she'll learn that the sit-down strategy she used as a toddler is not the best one to use an adult.