Grandparents....

 

I was driving through my favorite coffee shop the other day.  The barista told me that I owed her a little over $10 so I gave her a ten and several ones.  I told her to “keep the change”.  She looked nervous as she collected the change from the cash register and put it in the tip jar.  She said: “Do you want your ones back?”  Of course I did not, but I knew what was going on.  It was the same thing that happened to me 60 years ago.

I was 14 years old and told that I could help my grandfather for the first time on a furniture moving job.  He had a hauling business and moved just about anything using a 1933 Diamond-T stake truck.  The job was only 3 blocks away, so I walked over there, but about ½ block away I froze.  I was nervous and even though I knew everyone at that job – I turned around until I heard: “Chorge!”  That was the way my grandfather pronounced my name.  He saw me turn and from a half block away encouraged me to keep moving in his direction.  Everything went well on the job, and it was the first time I got paid for doing real adult work.

Just a few nights ago I dreamed I was sleeping in the snow behind my grandparents’ home.  The ground was covered in about 4 inches of snow.  The exposed areas looked more like weeds than grass. As I slowly got off the ground – I realized I was on the property line of my grandparent’s neighbor Oliver.  Oliver was a machinist.  I remember being in his garage and seeing all kinds of machinist tools and lathes.  It was dark except for a single hanging light bulb.  There was a strong odor of oil in the air.  He did machinist work in his garage for a while after he retired – but then he and my grandfather just sat on a bench next to his garage and talked.  They were both old Scandinavians, but I never saw them drink coffee in the afternoon. I knew my grandfather always had plenty on board by that time of the day.

The years went by and I did more work for my grandfather.  At one time or another I was joined by four different uncles (Bill, Jim, Carl, Tom), my father (George, Sr), and another man (Elwood) who was there most of the time.  My grandmother kept the books.  Things seemed to be going well, but I know my grandparents were concerned about me at times.  When I was a freshman in college, I got very ill with appendicitis and sepsis.  After recovering from that illness – I did not feel like doing much.  I was laying in bed one morning and woke up to see my grandfather standing there.  His spine was bent two different directions from decades of heavy lifting. When he walked, he led with his hips, and his shoulders were never square over his lower body.  I could tell from that outline it was him even before I saw his face.

He started an awkward dialogue intended to motivate me.  He wanted to make sure that I was not taking his criticism of colleges and professors too seriously.  He wanted to make sure I kept going to college.  I thought my grandmother might have put him up to it but it was not her advice.  She would tell me to avoid roadhouses – usually when I stopped in to say hello on my way to a roadhouse.  The only reason he was there was that he heard I was not doing well – and he thought he could motivate me like that first day working with him.

The years went by quickly after that.  I completed college and was in the Peace Corps half the world away when I got the letter from my grandmother.  “Your grandfather died – he always loved you and worried about you.” – it read.  That was back in the 1970s and he was about the same age that I am right now.  My grandmother lived another 20 years, and I saw her whenever I could.  Work and geography create quite a barrier.  When my grandmother died, my aunt gave me a bundle of all the letters that I sent her from East Africa.  I have not been able to reread them.  

I woke up earlier this week with the thought: “I wish I could go back to the 1970s and see my grandparents to let them know I did all right.”  The only thing my grandfather knew was that he had a neurotic grandson who was hesitant, cautious, and reluctant in life.  My grandfather seemed like a nervous guy, but when he was college age, he was hanging off the side of an oredock on a swing – bolting together the top deck with an air powered wrench while he sat 90 feet above Lake Superior.  He told me a few horror stories from the industrial accidents that occurred on that site while I was on the mend in the hospital.  He told me a lot of stories about his friends that were mostly about fishing but also what we used to call power stories. Power stories in the North Country were tales of supernatural ability.  It was implicit that there could be some embellishment.  One of his favorites was telling me about a man who ran a hauling business with a team of dray horses.  From handling reins all day long he developed extremely callused hands to the point that anyone who shook hands with him would “just shiver.”

My grandfather had tattoos.  They were probably from sometime in the late 1920s or 1930s.  If you looked close enough you could tell they were women wearing grass skirts and dancing.  My grandfather never talked about the tattoos, and it was before the time they were popular again. I don’t have any and he never spoke to me about the subject and whether he recommended them or regretted his decision.

In my grandfather’s dining room, there was a picture of him and his younger brother when they were children about 5 and 7 years old.  The picture looked nothing like him as an adult.  He was bald and both children in the picture had abundant long wavy hair.  I have a post about a shocking event that occurred on the paternal side of the family.   On the maternal side, the shocking event was that my grandfather’s brother left town one day and was never seen or heard from again.  Nobody has any idea about what happened to him.  Like the event of my paternal uncle being killed as a child, the disappearance of my maternal grandfather’s brother was never mentioned over the 20 years that I knew him.

My grandparents talked about the Great Depression and how it affected them.  They were frugal even though my grandfather ran a business and had a payroll.  They had a woodburning stove in the kitchen and used that to heat bath water.  They used a large, galvanized steel tub to bathe in and did not replace it with a modern bath tub until late in life.    

When I saw that young barista, anxious about my tip – I imagined for a minute that I was a grandparent.  When I say imagined - I mean in retrospect.  In real time, I knew I had to reassure her that things were OK and that there were no problems.  I could see she was relieved and happy. And for a minute – I realized that I was living both my life and my grandfather’s - like on that day back in 1960 when he kept me on track.  I also realized why it was important to help young people through generosity – even if it helped for only a few minutes. 

I did a lot of research about grandparents for this post – but it turns out that the research says almost exactly what you expect it to say.   A good relationship with your grandparents especially on an emotional level is good for children, adolescents, and even adult grandchildren.  The relationship needs to be balanced.  Social media contains all kinds of stories about grandparents not having good experiences.  Complaining seems to be what social media is designed for.  There is also the standing joke about why grandparents have a more fun relationship with their grandchildren than the parents do - they do not have to set as many limits as the parents and can overindulge them.  My grandparents were generous with their time, energy, and finances when our family needed support.  They had a great sense of humor.  They taught us how to be kind and resilient.  There is some literature on how the grandparents benefit as well.  But I don’t think that they considered anything beyond doing the right thing for their family and the fact that they really liked us. 

And getting back to my coffee shop drive through – my grandparents taught me the importance of supporting younger struggling generations – whether you are their real grandparent or not.   

 

George Dawson, MD, DFAPA

 

Note on the Grandfather Transference:  Transference is an important concept and feature of psychiatric treatment.  Physicians and psychiatrists in particular notice that the way patients interact with them varies over the course of their career.  Early on it is common to hear statements like:  "You look too young to be a doctor."  That might reflect concerns about adequacy of training or experience that could affect the treatment relationship.  As mid-career years approach there are fewer comments about age, but potential concerns about being more career and revenue focused to the exclusion of individualized care and knowing the relevant details about the patient. In the years approaching retirement, I think people realize that you have seen a thing or two and are probably competent, caring, and looking out for their best interest. People seem less likely to challenge formulations or treatment recommendations.  They are less likely to become confrontational.  I have termed this last phase as a period of grandfather (or grandmother) transference.  I don't think it has been studied but it seems like it does enhance the therapeutic relationship. 

 Additional Note on Furniture Moving:  Over the years many people found out that I was a professional furniture mover and requested help with moves.  Requesting help and taking advice are two different things.  Invariably something was done against my advice that resulted in damaged furniture.  My grandfather and the men working for him were proud of the fact that there was never an insurance claim against them for damaged furniture.  If you think about it furniture is fragile - mirrors, finishes, pianos, TVs, dishes and other breakable items, spindly legs, and moved in the same truck with heavy appliances.  Just a slight shift in the load can result in massive damage. 

So if a professional furniture mover tells you that covering your very expensive piano with a bed sheet and baling twine is not a good idea - believe them.

That seems like another parallel to psychiatry.  It seems like a job so easy anybody could do it.  It is just common sense - right?

Supplementary:  Could not work it in above but many years ago I heard a very positive review of a book about Grandmothers on public radio.  I have never been able to locate that book.  If anyone has that reference please let me know.

 

Graphics Credit:  Peachyeung316, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons.

An Unstated Developmental Milestone (or Two)

It is hockey season in Minnesota.

And like Little League seasons used to be, tens of thousands of pint sized hockey players are competing and practicing almost on a 24/7 basis.  Emotions run high as teams of widely varying levels of physical ability compete for the greater glory of their team.  Like most team sports that we all played as kids, there is a high emotional investment in winning.  None of the secondary goals of personal improvement, improved conditioning, and teamwork are generally considered.  Whether or not they can be realistically considered at a young age is an open question.  Clearly the adults carting all of these kids around and in many cases coaching them - want to see them win.  I don't know what impact the participation movement has had on winning.  In talking with some graduates of those systems, it offers limited protection.  At some point there is only competitive sports and a rude awakening that participation gets you so far.  At some point everybody does not get a trophy.

That realization is a game changing event for most people.  In your high school class of 300 people, you might be the fastest person in the quarter mile but you rapidly learn through a series of track meets that you will probably not be going to the Olympics.  The adaptation to that varies from just quitting the track team, to going to all of the meets and running as fast as you can, to questioning the coaching staff,  to trying performance enhancing drugs to see if that will give you the necessary edge.  It involves more than sports.  I have seen the same sequence of events play out in music and academics.  Being demoted from second to third chair in the orchestra section.  Not getting the perfect score or academic award in school.  In relationships, the break up of a first serious romantic relationship was the commonest reason I would see college aged students admitted to my inpatient unit and yet - none of them had a serious mental illness.  They were "suicidal" and emotionally distraught because they had not dealt with that kind of failure before.  My standard pep talk to them was that someday they would be as old and emotionally resilient as me and they would have scant recollection of ever seeing a psychiatrist in their life.  In many ways, relationships more than anything else highlights the developmental milestone I am referring to and that is dealing with failure - especially when that failure seems to have very high stakes.  A large percentage of the college students in crisis did not think that they would ever find a partner as ideal as the one they had just lost.

In Psychiatry School, they teach us all the normative models of cognitive and emotional development from various schools of thought.  Reading any modern text of child psychiatry (1) - the old developmental references based on theories by Freud, Piaget, and Erickson are gone.  They are now supplanted by specific emotion, cognitive, temperament, and attachment lines of development and their associated neurobiology. It is generally agreed that it is better to be resilient than not.  We now know that psychological trauma in childhood is a major cause of decreased resilience and that a fair number of children experience one of these traumatic events during childhood.   Apart from protecting children from these traumas as parents and society - what else can be done on an individual level?  During my career as a psychiatrist, I have made two observations that originated with other people that I think would be extremely helpful.

The first is the Sara Blakely story.  She is  the CEO of Spanx, a company that she started herself that became amazingly successful.  She has told her story repeatedly on a method that her father taught her to redefine failure as not trying rather than the outcome.  Her father took an active interest in his children and always inquired aboiut one thing they had failed at that week.  She said that he actually celebrated their failures at some point.  She discloses her failures at her company and encourages her employees to do the same thing.  Having survived several corporate cultures that thrived on blaming employees for various problems, I can imagine (if I try real hard) how refreshing that approach would be.  What would happen to all of these kids playing Minnesota hockey if they were able to just talk about what they were trying to do and how they failed at it?  Would it revolutionize the game?  If you are focused only on a win-lose outcome, you lose a lot of information along the way.  Information about yourself  and everybody else.  The starkest piece of information is that at any level of competition, the odds are stacked against you being the big winner.  You have to be able to see yourself as the Big Fish in a small pond at best.  You are probably not the one person in a million who is going to be at the top of that game.  In my estimation Sara Blakely's father was a genius when it comes to parenting.

I learned about the second genius father from of my coworkers before one of my morning inpatient team meetings.  We were the first ones there and she started talking about how she got into nursing.  Her father advised her to do volunteer work in the field when she was in high school.  She was reluctant to consider that idea.  At that point her father said her would pay her to do volunteer work in a field that would help her get into the health care professions.  At the time that struck me as pure genius.  I was talking with an extremely competent nurse.  I could also relate to not wanting to do much and not realizing why volunteer work as a teenager might be important.  That single idea by her father may have been the difference in her vocational choices.        

Those are my two favorite stories about parenting ideas that seemed like pure genius to me.  I am very interested in hearing what other people have discovered in real life that might have been useful in  improving resilience and getting to a more useful perspective on life - as opposed to the dry theories that we are all taught.  I would also like to point out that these issues are very difficult to study in a double blind clinincal trial, but I did encounter an experiment that was applied to a school class that also had very good results.  The study was highlighted by Ruth Shim, MD, MPH in her presentation Prevention in Psychiatry: A Public Health Approach given at the the University of Wisconsin 4th Annual Update in Psychiatry this year.  The research presented was on the Good Behavior Game (GBG), an intervention applied in the Baltimore City Public Schools in the late 1960s.  The game starts as three 10 minute sessions per week as a team competition.  The rules were focused on working quietly, being polite to others, getting out of one's seat with permission, and following directions.  Teams were rewarded with pencils and erasers if all of the members of the team followed the rules.  As the game went on the sessions got longer and students were given stars as rewards.  The games started with 1st and 2nd grade students and continued until the 6th grade.  Students were assessed up to the age of 19-20.  When the GBG classrooms were compared to standard classrooms there were significant reductions in alcohol use, smoking, and suicidal thoughts.  Looking at the males only there was less substance use and need for behavioral and substance abuse treatments.  The highly aggressive male strata had substantially less drug abuse, violent and criminal behavior (34% versus 50%), and diagnoses of adult antisocial personality disorder ( 40% versus 100%).

All of those results from the straightforward application of behavior therapy and peer pressure.  These are all good examples of basic ideas that seem to have had very good outcomes in terms of competent and successful adults.



George Dawson, MD, DFAPA


References:

1:  Anita Tharper, Daniel S. Pine, James F. Leckman, Stephen Scott, Margaret J. Snowling, Eric Taylor.  Rutter's Child and Adolescent Psychiatry (6th ed).  John Wiley & Sons, Ltd, The Atrium, Sounhtern Gate, Chichester, West Sussex, UK, 2015.  

2:  Embry DD. The Good Behavior Game: a best practice candidate as a universalbehavioral vaccine. Clin Child Fam Psychol Rev. 2002 Dec;5(4):273-97. Review. PubMed PMID: 12495270.


Attribution:

Hockey photo at the top is by y Ailura (Own work) [CC BY-SA 3.0 at (http://creativecommons.org/licenses/by-sa/3.0/at/deed.en)], via Wikimedia Commons at the following URL:  https://commons.wikimedia.org/wiki/File%3A20160416_AUTHUN_2883.jpg