Sunday, August 25, 2013

Adapting to a Mother with Problems

Mothers have historically held a prominent place in psychiatry.  The public often thinks that mothers are blamed for problems with their children, but the research on the matter is less clear and more subtle.  That is true even in the case of theorists who placed very little emphasis on individual psychopathology and more on problems within the family system.  The concept of "expressed emotion" evolved to describe a critical home environment that may be associated with exacerbations of schizophrenia.  Childhood adversity is the current concept that describes a number of factors that children must negotiate and that can be very problematic.  The goal of looking at these factors in childhood is an important part of any psychiatric evaluation, but not to look at someone to blame.  They are important indicators of the degree of resilience, their perspectives on important relationships and how their relationship with important childhood figures affected their personality development.  Almost everyone can recall a critical event that happened in their childhood and they can freeze it in time based on other memory associations.  I happened to hear a great example of this on the public radio show "This America Life" today.

The theme of the program today was babysitting and the piece I am interested in was the last segment called "Act Three.  Yes There is a Baby"   It is a recollection of how a son and daughter interacted with their single mother.  It is really a story of how two kids adapted to a mother who had severe problems.  It is also a story of how remote events continue to affect people over time.  One of the most surprising and consistent observations I have made in my discussions with people over time is how the relationships with parents and siblings are long lasting.  They don't seem to fade away over time.  Strong emotions and patterns of interpersonal interaction persist for decades if not an entire lifetime.  Having no contact with your parents or siblings for prolonged periods of time usually has little effect on these dimensions.  This story starts out with a teenage daughter making up a family - the McCrearys who she was babysitting for in order to escape her mother's limitations on her freedom  to move around in the 1940s.

This story interested me for a number of reasons, not the least of which is the way it echoed many themes that I have heard from people as well as my own personal experience.  The other important point is that it is a true story.  With the current constraints on the discussion of true stories by medical professionals, I think we will need to rely more and more on true stories that are openly disclosed in the media.  The eliminates any possibility of professional intervention but it allows for the emphasis of important points.  In this case I have linked to the transcript because the audio file is not available until later.  I agree with the disclaimer on the web site that you should actually listen to the audio file to get the full impact and hear the story in the voices of the people involved.

The story begins with the son Myron telling Ira Glass about how the rules about staying out from the family home were very different for him and his sister.  He enjoyed a fair amount of freedom but his mother restricted his sister to going out to church dances.   When his sister Carol is contacted, she describes a situation that is much worse.  She was followed by her mother's friends.  Her mother began calling her a whore at an age before she knew the meaning of the word.  Whenever she was employed as a babysitter, her mother needed to know the number in order to check on her.  She would also remind Carol and Myron that when their father died she got a lot of advice that she she put them both in an orphanage.  She did not and described it as the biggest mistake in her life.

In order to adapt to her mother's restrictive and abusive parenting style, Carol invented a family and would say that she was babysitting for this family when she was really sleeping out on the beach or staying with friends.   Mr.  McCreary was an FBI agent and therefore she could not give her mother their telephone number.  She was also being paid for babysitting in stocks and bonds, so there was no proof of babysitting in money.

The interesting psychiatric aspects of this story are basically threefold.  Early on Myron points out that the whole concept of "imaginary people" was something that he and his sister got directly from his mother.  She talked about seeing a lawyer, a psychiatrist ("psycholotrist"), and a doctor.  In every case the appointments with these imaginary professionals was foreboding.  She told the children that she was seeing the lawyer in order to make arrangements to put them in an orphanage.  The psychiatrist told her that her children were driving her crazy.  The doctor told her she was going to die.

Myron tells the story of coming home one day when he was ten years of age and his mother telling him that she was arranging for him to go to an orphanage with a local priest.  He decided he would go away to school at that time, even though he knew there were any number of ways he could have sabotaged it, basically because his mother had been threatening him with an orphanage "all of my life".  As a part of that process his mother wanted reassurances that he thought about her "crying my eyes out" when he was at  his "fancy school".  He decided from that point on (at age 10) that he would never ask his mother for anything or look to her for anything again.  He had that insight when he was 30 years old.

Carol lashed out at her mother when she was about 35 years old.  Her mother reacted by crying and it was the first time she had ever seen her cry.  When her mother stopped crying she said that she did the best that she could have and this lead Carol to the insight:

"And I thought, oh my god, she did. Her best was so bad. Her best was so empty. But she couldn't do any better.."

Accepting that truth and recognizing the importance that her mother had to her grandmother and aunt lead Carol to modify her emotional response to her mother.

The themes in this story are important in psychotherapy and form the basis for most psychodynamic therapies.  Although they never made it explicit Carol and Myron both had unique strategies to adapt to their mother's problems.  This is a story that has universal appeal.  Everyone has landmarks in his or her personal history when an interaction with a parent or a sibling is an organizing event in the rest of their life.  The number of possible decisions and behaviors based on that event and their complexity are are well illustrated in this family history.  The resilience of these two children and how they overcame childhood adversity is remarkable.

George Dawson, MD, DFAPA

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