Who is driving the car?

I am at my parent’s house.

My mother and I and the baby, a toddler, go out to the car which is a huge newish SUV. I open the back door and see a drawing lying on the seat, beside the car seat. It is a drawing of my son, from a photograph. My mother has written on it, her ideas about how she wants to do the painting. I took the photograph and know it: my son has an exuberant joyous toddler expression. I climb in to the SUV. My mother gets in the front and turns the car on. She pulls forward and I start screaming, “STOP! STOP DON’T DRIVE! THE BABY IS NOT IN THE CAR!” My mother is pulling forward and backing, in confusion. She stops.

I leap out and search. Under the car by the back wheel, but not under it, is a kitten. A black kitten, lying on its side. I reach and very gently pick it up, supporting its spine. I am crying. The kitten cries as I pick it up, with pain. I say, “She’s hurt! I am going to die!”

I wake up.

I think about the dream. Even though there is a picture of my son in the car, I am a teen in the dream. The toddler is not my son. The toddler is not my daughter. The toddler is my sister. My parents had old cars, never a new SUV. The house in the dream was my parent’s house in Alexandria, Virginia. We moved there when I started ninth grade and my sister started sixth. My parents sold the house and moved in 1996.

Who is driving the SUV? Is there a responsible adult? Are they taking care of the children? Or are they driving recklessly and leaving the children to try to care for each other? Some adults are not responsible and should not be driving.

 

My son took the photograph of my daughter in 2011 for a school project, recreating a movie poster: True Grit.

The future of medicine

we recognize the true embodied mind
we stop the stigma of the many beaten down
the damage done in childhood caught in time
hearts open and lift the broken off the ground

we learn that diagnoses are a crutch
drugs plaster over deep and seeping wounds
mental labels hurt the patients oh so much
we learn to listen: broken hearts sing grieving tunes

cruel medicines and thoughts are shelved for good
gentle boundaries surround hearts to keep them safe
we rise as friends and families and doctors really should
the angry monster revealed as longing waif

damage done in childhood to the brain
lays survival pathways that we no longer call insane

The photo is me and my sister Chris. I do not know who took it, but I think it was at my maternal grandparents. They are deceased, my parents are deceased, my sister is deceased. I don’t know who to credit.

Adverse Childhood Experiences 2: Out on a Limb

We are approaching a seismic shift in psychiatry. I am now going out of a limb to predict the direction we will go in.

The allopathic medical community will resist, including many psychiatrists. But it is the neurobiologists and brain imaging and psychiatrists who will prevail. If the creek don’t rise and we aren’t hit by a giant asteroid, nuclear winter, devolve into fighting over the remaining arable land as the world heats up….

I have been thinking about this all through my career, but especially since the lecture on adverse childhood experiences, which I heard in Washington, DC about ten years ago. I wrote about that lecture on January 6, 2015. The lecturer was a woman. She said that it appeared that the brain formed differently in response to childhood adverse experiences. She said that we don’t yet know what to do with this information.

Staggering understatement. I went from that lecture to one about ADHD. The lecturer was male. He said, “Children diagnosed with ADHD have brains that are different from normal children on PET scans and functional MRIs. We don’t understand this.” He sounded puzzled. I thought, he didn’t go to the previous lecture….

Childhood adverse experiences are scored zero to seven. I score a five. I am at high risk for addiction. I assumed this when I realized at age 19 that my father was an alcoholic and my mother was enabling. I was very very careful about alcohol. I tried pot twice and didn’t like it. I refused to try anything else, and refused benzodiazepines when I was depressed: they are addictive. With an ACE score of five, I am also at higher risk than a person with a score of zero for ALL mental health diagnosis: ADHD, depression, bipolar disorder, obsessive compulsive disorder, etc. People with a score of five had a 60% chance of being diagnosed with depression compared with a 10% chance in people with a score of zero over the life of the study. In the last fourteen years I’ve only been diagnosed with a “grief reaction” which is a temporary reaction to grief. It is also called an adjustment disorder. High adverse childhood experience scores are also at higher risk for morbidity and mortality from heart disease, emphysema, arthritis, basically everything and tend to die younger.

What this means, I think, is that our brains are plastic in utero and in childhood: the wiring is put down in response to the environment. This is adaptation. I have crisis wiring: my mother had tuberculosis when I was conceived and born. Really, from an evolutionary standpoint I AM weird: babies whose mothers had tuberculosis died. Quickly. I was saved because my mother coughed blood one month before I was due. A lot of blood. She thought she had lung cancer and would die. The fetus is bathed in those stress hormones, grief, fear….

I was removed from my mother at birth to save my life. I then was removed from people at 4 months and at 9 months. I grew up trying to be independent and highly suspicious of adults.

I predict that we are going to revamp all of our ideas about mental health. The brain wiring is set up depending on the environment, physical and emotional, that the child grows up in. My friend Johanna was outraged in college when we learned that the fetus and placenta basically take over the hormones of the woman for 9 months. “I’m not letting some baby grow in me and do that!” Johanna said. “I am going to figure out how to implant the pregnancy in a cow. You take good care of the cow and you can drink beer through the whole pregnancy! The cow won’t even notice when the baby falls out!” She has three children, an MD and a PhD in genetics. She did not use a cow.

The brain wiring is an adaptation to the environment. If there is war or domestic violence or addiction or mental health problems, the child’s brain kicks in emergency wiring. This is to help the child survive this childhood. As an adult they are then more at risk for mental health disorders, addiction and physical health disorders.

In the end, the sins of the parents, or the terrible circumstances of the parents, are visited upon the children. We have to take care of the children from the start in order to be healthy.

And people who have low adverse childhood experience scores don’t understand. They grew up with nice people and in a nice environment. They wonder why people can’t just be nice. The fear and grief and suspicion and emotional responses that appear maladaptive in adults, that is what helped people survive their childhoods. That is what I remember each time I see an addict in clinic, or someone who is on multiple psychiatric medicines, or someone who is acting out.

Don’t be perfect, ok?

This reminds me of a kid’s book I had, or possibly have. I may still have it. I don’t exactly know where it is. I’m not perfect. Anyhow, the book is about Peter Perfect, who did everything right. The drawings of the other kids being “bad” were fabulous. At the end the secret is revealed: Peter Perfect is a robot, with a large wind up key in the middle of his back.

I got this link from Big Red Carpet Nursing’s blog, about perfectionism being a big risk for suicide. Many thanks!

http://psychcentral.com/news/2014/09/26/perfectionism-linked-to-suicide/75399.html