Category Archives: family

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Safe harbor

For Ronovanwrites haiku challenge #70, prompt words cover and color.

cover, shelter all
colors, would you harbor me
should be a cover

Sweet Honey in the Rock: Would you harbor me? https://www.youtube.com/watch?v=i0XBXJjoXJ4

I thought about cover meaning shelter and meaning the song, and the refugees needing shelter, harbor and cover. We are frightened and seek cover, shelter, harbor. Who do we have to harbor us but each other?

The photo is a synchronized swimmer in 2012.

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Adverse Childhood Experiences 8: Social cues

I am thinking about social cues for people with high Adverse Childhood Experience scores. With crisis brain wiring the response to social cues may be very different than what is considered the acceptable “norm”.

I always miss the cue when someone says “see you later”. I think “When?” Then I realize it’s a social comment and they do not in fact plan to see me later. I have a moment of disappointment. I do the same thing when someone says, “Let’s get together for dinner.” or “Let’s have coffee some time!” or “I will call you back!” or “Why don’t you come to our cabin some day?” Yes, I think, when?

And then I think “Liar.”

So I fail social cues….. or do I? Maybe I am not responding to the “correct” or “conventional” or “nice” social cues.

My father drank too much and especially while I was in high school and college. And my mother would enable and cover up and pretend nothing was happening. Children in this situation, which is way too common, develop special skills.

My sister was three years younger. As adults we discussed the stages of drinking and which one we hated most. We would both walk in the house from school with trepidation. In the door and almost feeling the air: what is happening? Am I safe? Do I need to hide? How dangerous is it? How much will it hurt?

I walked in once during high school and missed the cue. I was thinking about something. I thought my father was asleep in the kitchen. I went in to get something. I was very quiet so as not to wake him. I made a cup of tea.

He was not asleep, or else he woke up. And it was the worst stage, or the one I hated most.
Not physical violence. But he started talking. One of things he said was “You can tell me anything.” Now, he meant it. But he was crying by then and I knew I did not want to tell him anything and all I wanted was desperately to leave the room. And neither my sister or my mother was home. Finally I was crying too, because I said “I just want to go read my book.” and he was more crushed and maudlin and emotional and crying. And I tore out of the room and up to my room, as my mother walked in.

I did not cry much. Ever.

I refused to talk to my mother about it.

The next day she said to me, “Your father told me that you were talking about Lamont.” Lamont Cranston was a very beloved cat, The Shadow, who was missing now. Dead, we thought.

I said nothing. Because we had not talked about Lamont. So either my father was lying or else he’d had a blackout, didn’t remember and was making shit up. And if I told my mother the truth, she would back him and deny what I said or make it into a joke.

The stages my sister and I identified were:
1. sober
2. a little bit
3. goofy/silly/makes no sense
4. crying
5. asleep

We were ok with 2 and 5. I don’t think we saw 1 for years. We disliked 3 intensely, especially in public and especially when our mother was doing a cover up dance. And 4 we hated.
And yet I loved my parents and mostly miss them now that they are gone. Except when I remember things like this.

So, what is the point?

I miss “social cues” because that is NOT what the crisis brain, the ACE score brain, pays attention to. I am paying attention to far more intuitive things: body language. Whether what the person is saying matches what I know about them and what they have done in the past. I am looking for whether this person is telling me the truth.

I don’t trust instantly. Why would I?

I said to a counselor once that reading the “cloud” around the person was terribly useful in medicine but made me a social misfit. “I don’t know how to turn it off.” I said. She grimaced and said, “Why do you think I went into counseling?” She said, “I can’t turn it off either but I have learned to ignore it during social situations.” I was in my forties before I realized that there are people who don’t sense this cloud, who trust people until the person is dishonest, who understand that it is just fine to say “Let’s get together.” and not mean it.

Because actually, when someone says “I’ll see you later.” and they don’t mean it, they are saying an untruth. They are not planning to see me later. They don’t mean it. And my brain automatically files that under evidence that this person is not trustworthy. To them it is a social cue that is polite. To some of us, it is clearly something that is not actually true. I pick up on a cloud of social cues, but not the ones that are acceptable or conventional. And I am not the only one.

my sister on the left and me on the right, in the 1960s

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Why care for addicts?

Why care for addicts?

Children. If we do addiction medicine and help and treat addicts, we are helping children and their parents and our elderly patients’ children. We are helping families, and that is why I chose Family Practice as my specialty.

Stop thinking of addiction as the evil person who chooses to buy drugs instead of paying their bills. Instead, think of it as a disease where the drug takes over. Essentially, we have trouble with addicts because they lie about using drugs. But I think of it as the drug takes over: when the addict is out of control, the drug has control. The drug is not just lying to the doctor, the spouse, the parents, the family, the police: the drug is lying to the patient too.

The drug says: just a little. You feel so sick. You will feel so much better. Just a tiny bit and you can stop then. No one will know. You are smart. You can do it. You have control. You can just use a tiny bit, just today and then you can stop. They say they are helping you, but they aren’t. Look how horrible you feel! And you need to get the shopping done and you can’t because you are so sick…. just a little. I won’t hurt you. I am your best friend.

I think of drug and alcohol addiction as a loss of boundaries and a loss of control. I treat opiate overuse patients and I explain: you are here to be treated because you have lost your boundaries with this drug. Therefore it is my job to help you rebuild those boundaries. We both know that if the drug takes control, it will lie. So I have to do urine drug tests and hold you to your appointments and refuse to alter MY boundaries to help keep you safe. If the drug is taking over, I will have you come for more frequent visits. You have to keep your part of the contract: going to AA, to NA, to your treatment group, giving urine specimens. These things rebuild your internal boundaries. Meanwhile you and I and drug treatment are the external boundaries. If that fails, I will offer to help you go to inpatient treatment. Some people refuse and go back to the drug. I feel sad but I hope that they will have another chance. Some people die from the drug and are lost.

Addiction is a family illness. The loved one is controlled by the drug and lies. The family WANTS to believe their loved one and often the family “enables” by helping the loved one cover up the illness. Telling the boss that the loved one is sick, procuring them alcohol or giving them their pills, telling the children and the grandparents that everything is ok. Everything is NOT ok and the children are frightened. One parent behaves horribly when they are high or drunk and the other parent is anxious, distracted, stressed and denies the problem. Or BOTH are using and imagine if you are a child in that. Terror and confusion.

Children from addiction homes are more likely to be addicts themselves or marry addicts. They have grown up in confusing lonely dysfunction and exactly how are they supposed to learn to act “normally” or to heal themselves? The parents may have covered well enough that the community tells them how wonderful their father was or how charming their mother was at the funeral. What does the adult child say to that, if they have memories of terror and horror? The children learn to numb the feelings in order to survive the household and they learn to keep their mouths shut: it’s safer. It is very hard to unlearn as an adult.

I have people with opiate overuse syndrome who come to see me with their children. I have drawings by children that have a doctor and a nurse and the words “heroes” underneath and “thank you”. IΒ  have had a young pregnant patient thank me for doing a urine drug screen as routine early in pregnancy. “My friend used meth the whole pregnancy and they never checked,” she said, “Now her baby is messed up.”

Addiction medicine is complicated because we think people should tell the truth. But it is a disease precisely because it’s the loss of control and loss of boundaries that cause the lying. We should be angry at the drug, not the person: love the person and help them change their behavior. We need to stop stigmatizing and demeaning addiction and help people. For them, for their families, for their children and for ourselves.

I took the photo of my daughter on Easter years ago.

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Gleaning

This is for Ronovanwrites weekly haiku challenge #70, with prompt words crane and gold.

quick look gleaning fields
sandhill cranes glean gold near Sand
Dunes National Park

I lived in Alamosa, Colorado for three years, at 7500 feet in the San Luis Valley, land of cool sunshine. The sandhill cranes would migrate through and glean the potato fields, flocks with thousands. There were more cranes than people at the height of migration. And in the northeastern corner of the Valley, surrounded by the Sangro de Cristo Mountains and the San Juans, is the Great Sand Dunes National Park and Preserve, with dunes up to 600 feet high. We were surrounded at 7500 feet by 14,000 foot peaks and passes out the Valley in all four directions. It is an amazing place.

I took the photo in 2007 at the dunes: I chose this one to try to give an idea of the scale…..we had just climbed up to the top of the first dunes….

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Where oh where is love?

How could we have love without grief?

The US culture seems to suppress grief, take grief away, heal grief, get over grief, but think about love without grief.

Could we love someone if we didn’t grieve when they died?

No. We couldn’t. That wouldn’t be love. Or that would be the pale shadow of love, love without loss, love that turned from the grave and forgot.

We cannot love without grief, so we need to make room for grief. We need to stand by each other during grief. We need to help each other, be present, be there, say the wrong thing, say the right thing, say nothing and just give love.

Love builds the Taj Mahal. Love writes Rumi’s poems. Love is the memories of the person we loved, we tell our children about them, we hold them in our hearts.

Love loves without logic, without sense. Love in spite of alcohol, addiction, lies, how can a person love an abuser? They love the person, not the abuse. They love the person, not the actions, not when the alcohol takes over, when the meth takes over, when the oxycontin takes over. Love loves the whole person and grieves the damage.

Love and grief are intertwined, a rosebush with thorns, there is no one without the other. No joy without despair, no light without dark, no you without me, no joining without separation.

I enter grief as I enter love, whole heartedly, oh, I may be afraid of the dark but I go there anyhow, I know as the waves close over my head and I sink into the depths:

There is no love without grief.

 

The picture is my mother, Helen Burling Ottaway, in high school. She died of cancer in 2000 and I still miss her terribly.

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Songs to raise girls: Long Black Veil

 

This and The Fox are what I think of as the two core family songs. We sang this from as early as I can remember and my father played the Band’s version on the record player all the time. I taped his records to take to college…

This is the song my parents chose to raise girls on? Oh, and I do have it memorized….

Ten years ago on a cool dark night
There was someone killed ‘neath the town hall light
There were few at the scene and they all did agree
That the man who ran looked a lot like me

Ok, it starts with a murder. Someone is killed, in the town, at night. Be careful, little girls, bad things can happen at night.

The judge said “Son, what is your alibi?
If you were somewhere else then you won’t have to die”
I spoke not a word although it meant my life
I had been in the arms of my best friend’s wife

It is about infidelity and not only infidelity, but infidelity with his best friend’s wife. This song is a morality play. He doesn’t speak. I see the magazines at the counters in the grocery store and think about how different this song is from our current culture. Divorce and splashed all over the papers, that’s what the celebrities do today.

She walks these hills in a long black veil
She visits my grave where the night winds wail
Nobody knows, no, and nobody sees
Nobody knows but me

So she doesn’t speak either. She remains faithful to him in visiting his grave, but the marriage must continue, because she only goes at night.

The scaffold was high and eternity neared
She stood in the crowd and shed not a tear
But sometimes at night when the cold wind moans
In a long black veil she cries over my bones

She watches him die for what they considered a sin. This song is about ethics, really. The two of them had broken their code of honor and paid the price, which was that he died for a different crime. And did the man who really killed the person in the first stanza then go free?

Why wouldn’t they speak up? Perhaps she had children and he couldn’t support them. Perhaps they truly considered it a sin, a dishonor, a horrible mistake. Perhaps honor and honoring his best friend was more important than love…. Our current culture seems to think that love conquers all, but it doesn’t in this song. Did they do the right thing? This is a song to discuss and to think about and yes, a song to raise girls.

Though I think the husband and any children would know that there was something…. a parent and partner can’t really hide that deep sorrow….

It was written by Danny Dill and Marijohn Wilkin in 1959 and originally recorded by Lefty Frizzell.

Lefty Frizzell: [https://www.youtube.com/watch?v=50k18gL76AU]

The Band, 1968

Johnny Cash, 1968

Lots of others…. and us.

The photo is me and my sister, probably in 1993 or 1994.

 

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Songs to raise girls: Pack up your sorrows

This song interests me. It is the fourth in my series about the songs that my sister and I learned growing up.

When we recorded our family songs, my sister said she liked it. I said, I think it is creepy, with that juxtaposition of a sweet tune and then words that are not so sweet.

No use cryin’
Talking to a stranger
Namin’ the sorrows you’ve seen

Oh, ’cause there are
Too many bad times
Too many sad times
Nobody knows what you mean

If somehow
You could pack up your sorrows
And give them all to me

You would lose them
I know how to use them
Give them all to me

The line that bothered me was “I know how to use them”. What does that mean? Use them for what?

No use ramblin’
Walkin’ in the shadows
Trailin’ a wanderin’ star

No one beside you
No one to hide you
An’ nobody knows where you are

Ah, if somehow
You could pack up your sorrows
And give them all to me

You would lose them
I know how to use them
Give them all to me

And how could you give your sorrows to someone else? The singer is offering to listen to sorrows but also take them away. “You would lose them.” And then the singer “knows how to use them”.

No use roamin’
Walking by the roadside
Seekin’ a satisfied mind

Ah, ’cause there are
Too many highways
Too many byways
Nobody’s walkin’ behind

Ah, if somehow
You could pack up your sorrows
And give them all to me

You would lose them
I know how to use them
Give them all to me

I never got around to asking my sister if it was the tune she liked or the words or what it meant to her. I chose to play that recording at her Washington memorial. I could not go to her California memorial because I was too ill. My father had terrible emphysema and was on oxygen. I thought I had pertussis but it turned out to be systemic strep A, which hurts. At any rate, I was too sick to travel. Her Washington Memorial was a month or two later, when I was well enough to organize it…..

You would lose them
I know how to use them
Give them all to me

It is by Pauline Baez. The version by Richard and Mimi Farina is the one I’m familiar with, so my parents probably had the record:Β  https://www.youtube.com/watch?v=U4LbU8w7Th4.

Joan Baez, Pauline and Mimi Farina were sisters. Joan Baez recorded it https://www.youtube.com/watch?v=NAMe1bRW8Ao. So did Peter, Paul and Mary: https://www.youtube.com/watch?v=IVxNleqVpx4.

And so did Johnny Cash and June Carter: https://www.youtube.com/watch?v=_ctVhDEuTYE

The picture is a music party at my house in 2009, my father seated and Andy Makie on harmonica, Jack Reid standing with the guitar.

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Swim fast

This is for Photrablogger’s Mundane Monday Challenge #31. I shot this at the senior swim meet in our 1950s pool. The windows are covered so that everyone can see. The team members each have a secret sister for the meet and deliver posters and gifts at school. This was shot with a zoom lens, across the pool, back lit by the afternoon sun…..

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Adverse Childhood Experiences 7 : Revisiting Erikson

Welcome back, to Adverse Childhood Experiences, and I have been thinking about Erikson’s Eight Stages of Psychosocial Development.

These were mentioned in medical school and in residency. I was in medical school from 1989 to 1993 and in Family Practice Residency from 1993 to 1996. Family Practice is at least half psychiatry, if you have time. We are losing the time with patients in order to achieve “production”. I complained about the 20 minutes I was allotted per patient and was told that I should spend 8 minutes with the patient and 12 minutes doing paperwork and labs and calling specialists. This is why I now have my own practice. A new patient under 65 gets 45 minutes and over 65 gets an hour and my “short” visits are 25 minutes. I am a happy doctor. And on the Boards last year I scored highest in psychiatry….

So, back to Erikson. The first stage, at birth to one year is Basic Trust vs Mistrust. “From warm, responsive care infants gain trust or confidence that the world is good.”

I was taught that people would have to “redo” the stage if they “failed”. Let’s look at that a little more closely.

Take an infant in a meth house. No, really, there are babies and small toddlers that have addict parents, alcohol, opiates, methamphetamines. We do not like to think about this.

A social worker told me that the toddlers from a meth house were really difficult to deal with. They do not trust adults. The first thing they do in foster care is hide food.

Hide food? Well, adults on meth are not hungry, sometimes for 24 hours or more, and they are high. So they may not feed the child.

Now, should this child trust the adult? No. No, no, no. This child is adaptable and would like to survive. So even under three they will learn to hide food. In more than one place. This is upsetting to foster care parents, but perfectly understandable from the perspective of the child.

So has the child “failed” the first stage? Well, I would say absolutely not. The child looked at the situation, decided not to starve and learned not to trust adults and hid food. Very sensible. Adaptive.

Is the child “damaged”? That is a very interesting question. After 25 years of family practice medicine I would say that no, the child is not damaged. However, the child has started out with a “crisis” brain. The brain is plastic, all our life, and so this child did what was needed to survive.

Is the child “sick”? Again, I would argue no, though our society often treats the child as sick. We think everyone should be “nice” and “warm” and “why isn’t he/she friendly?” Well, if you started in an addiction household or a crazy household or a war zone, it would not be a good adaptation to be warm and fuzzy to everyone.

How do we treat the adult? In a warm fuzzy nice world the child would have a foster parent who adored them, was patient with them, healed them and they would be a nice adult. I have a friend who said that foster care was so bad that he chose to live in an abandoned car his senior year rather than stay in foster care. He couldn’t play football because he had to get back to the car and under the layer of newspapers before it got too cold. I am sure that most foster parents are total wonders and angels. But some aren’t.

I have a person who says that he lived on the streets from age 8. He did get picked up and put into foster care. He kept running away. “The miliary loved me because I could go from zero to 60 in 60 seconds.” That is, he has crisis wiring. He is great in a crisis. The military is a sort of a safe place, because it has rules and a hierarchy and stands in for the failed parenting. Expect that then you get blown up by an AED in Afganistan and hello, that makes the crisis wiring worse.

How DO we treat the adult? We treat them horribly. We say why can’t this person be nice. We diagnose them we drug them we shun them we isolate them we as a society discriminate against them deny them and we are a horror.

I get so angry when I see the Facebook posts where people say “surround yourself with only nice people”. Ok, how dare you judge someone? You don’t know that person’s history. You don’t know what they grew up with. How dare they say that everyone should be NICE.

I am a Veteran’s Choice provider. I have 6 new veterans in the last 3 months. I suspect I will get more. They are not “NICE”. They come in suspicious, hurt, wary, cadgy. And I don’t care, because I am not “NICE” either. We get along just fine.

When I run into someone who isn’t “NICE”, I think, oh, what has happened to this person? What happened to them when they were little? What happened to them as an adult? How have they been hurt?

Pema Chodron writes about sending love: to your loved ones, to a friend, to an acquaintance, to a stranger, to a difficult person and to an “enemy”.

Send love. And do something about it. Help at your local school, help families on the edge, help single parents, sponsor a child to a sport if their parents can’t afford it, pay for musical instrument lessons, do Big Brother/Big Sister, become a “grandparent” to a child at risk, be a good foster parent, donate to addiction care….

The photo is from 2007, when my children and I visited their father in Colorado. A stranger in the parking lot took it at our request…..