Basic Trust

“Ultimately, there can be no complete healing until we have restored our primal trust in life.” (Georg Feuerstein, 1947—2012)

“Love cannot live where there is no trust.”  (Edith Hamilton, 1867—1963)

I look at my new grandson, sleeping, eating, eliminating, crying, opening his eyes while slowly processing the sights, sounds, smells, and textures of a new and unfamiliar world, helpless now, helpless for many weeks and months to come.

Helplessness is the primal life experience.  The infant, who can only protest and wait, must rely upon the benevolence and attentiveness of the surrounding caretakers.  For an infant, being wet, dirty, hungry, thirsty is beyond personal remedy.  And it is from the earliest life experiences, when those needs are met, that a child begins to develop trust in their world.

Psychologist Erik Erikson, known for describing 8 stages of development covering the lifespan, called infancy the stage of Basic Trust vs. Mistrust. An infant learns trust when breasts and bottles appear on time, when diapers are changed as needed, and solace is offered in times of distress. If an infant’s needs are met; if when hungry . . . fed, if when dirty . . . cleaned and changed, if when crying . . . comforted, and if when tired . . . helped to sleep, that child will develop a basic trust in the benevolence of their world.

Unfortunately, for some, life begins very differently. Too often, in my practice, I saw children who as infants were neglected or abused.  Rather than beginning life surrounded by caring and trustworthy others, basic needs often went unattended. The world, as they first experienced it, was a hurtful and unreliable place to be. Understandably, from early life experiences, they learned to see ‘caretaker’ others through lenses of doubt and suspicion.

Mistrust persists.  For the child who began life mistreated and mistrusting, years later, even caring adults are perceived as anything but caring. A child who mistrusts is a child who is alone and frightened. A child who mistrusts feels that they must fend for themselves. Do something, do anything, rather than feel helpless.

These children will adopt a variety of strategies to feel in control. Some learn to provoke, for it is better to be in control of the time and place of mistreatment, rather than have no control or warning.  Some children will invent an explanation for their mistreatment, usually self-blame.  “I was mistreated because I deserved it.”  It is better to have a reason, any reason, rather than none at all.

Some of these children learn to mask their feelings, concealing from others the turmoil within, for others cannot be trusted to understand the internal chaos and darkness.  As they grow, some will continue to mask feelings by numbing with drugs and alcohol.  Some will ward off feelings of loneliness and helplessness by finding safety in numbers, often affiliating with gangs or cults. Some become like the bullying adults, controlling their inner turmoil by controlling weaker others.

To trust or not to trust, for the infant, that is the question. The question is answered during the youngest years of life.  That answer can last for a lifetime.

I look at my new grandson, helpless, trusting.

Parenting the Intellectually Disabled Child

When a child is intellectually disabled, the demands can become exhausting. Marriages become stressed. There is significant impact upon siblings, as parent time is often consumed by the excessive needs of their disabled child.  The challenges are chronic, the demands are life-long.

A child with intellectual disabilities needs devoted parenting and a team of helping, supporting adults including educational specialists, behavioral specialists, and medical specialists skilled in working with this population.

In my practice, I saw many children with intellectual disabilities.  They came to see me for a variety of reasons; disruptive behaviors, impulsive behaviors, and occasionally destructive, aggressive, or self-injurious behaviors.  These children were vulnerable to depression and anxiety.  Sometimes, because of their diminished cognitive capacity, these children came to me overwhelmed, in a state of panic, some even hallucinating.

Early in my career, I’d had very little training working with these kids. What I learned, I often learned on the fly.  However, over the years, through the many conversations I had with these parents, I compiled a set of parenting tips:

·       There is a fine line, balancing hope and reality.  It is important to determine what is and what is not within your child’s capacity.  It is okay to expect a lot, just not the impossible.

·       Don’t cripple your child with pity, pity for them or self-pity.  Set goals. Have rules and expectations.

·       Siblings may feel over-burdened with responsibility caring for a disabled sibling.  They may feel deprived of parent time and attention.  However, they may also develop a deep sense of compassion and caring for others.  Be sensitive to their feelings and demands.

·       Live your life as fully as possible, attending not only to the demands of your special-needs child, but also attending to your other children, your partner, your spirituality, your friendships, your interests, and your health.

·       Don’t isolate yourself or your child due to shame or embarrassment.  Ignore the looks of others.

·       Network with other families and support groups.

·       Implement a well-conceived behavior modification plan.  Seek professional assistance if-needed. 

·       Encourage acquisition of good communication, to the maximum of your child’s capability.  Seek professional assistance if-needed.

·       Encourage social participation—in special camps, in Special Olympics, etc.

·       Teach your child traits of good character—kindness, honesty, perseverance, courage.

·       Encourage the acquisition of independent living skills to the maximum of your child’s capability.

·       Teach and expect chores and jobs around the house.

·       Encourage and support the development of employable skills.

·       Plan ahead for your child’s emerging sexuality.  Have clear and concise rules about appropriate and inappropriate behavior.  Supervise the environment, allowing your child access to media compatible with intellectual and emotional maturity, not physical maturity.  Define and enforce rules of modesty and privacy in the household.

·       Monitor phones and computers. Protect your child from potential predators.

·       Plan ahead for your child’s adult care, legal protections, and financial needs. Begin this process many years in advance.  Seek out organizations and support networks that can assist you through this daunting task.

I often witnessed in these parents a great deal of courage, dedication, and love for their children. I hope that, over the years, my tips helped some of these parents to navigate their challenges with a bit more direction and confidence.  Whatever I was able to teach, I know that I was taught as much or more in return.

Economics

When my son was little, in his infinite curiosity he would spend hours asking the question, “Why?”  Just when I thought I had given him the answer, he invariably asked another, “Why?”  One day, trying to be patient, I answered a long string of whys.  Eventually, I stumbled upon the answer that seemed to satisfy his need to know, and my need to explain.

“Daddy, why?”

“Son, economics.”

And thus, I discovered The First Law of Economics:  If the question is why, the answer is economics.  Wars are fought because of economics.  Candidates win or lose elections because of economics.  Star actors and athletes are obscenely overpaid while star teachers remain obscenely underpaid . . . and why?  Economics.

Personal choices are the result of economics.  Most every choice we make, we consider in the balance.  What’s the price?  What’s the prize?  Is it worth it?  Can I afford it?  Or as advertisers like to ask us, can I afford to live without it?  It’s human nature to want to get the most for the least.  We search out bargains.  We buy a dollar lottery ticket with the outside hope of winning millions.  All of this which leads me to The Second Law of Economics:  People want the greatest prize for the lowest price.  Corollary to the Second Law:  Advertise either the low price of having, or the high price of not having.

In medical practice the price and prize is eruditely referred to as the risk-benefit ratio.  Any medication, any medical procedure, has possible risks and side-effects that must be weighed against the potential for benefit.  There is no medicine and no procedure that comes risk-free.  Every prize has its price, which segues nicely into the often ignored Third Law of Economics:  There is no free lunch.

No matter the prize, there is a price to avoid . . . the compromise of one's beliefs and principles.  Few prizes, if any, justify the cost of sacrificing personal integrity. Over the years, I have observed this Fourth Law of Economics: The greatest threat to beliefs and principles is poverty and wealth.  The Fourth Law of Economics paraphrased:  Money, too much or too little, tends to corrupt.

I started my blog 4 ½ years ago, one week after I began my retirement.  Monday, after 4½ years of retirement, I go back to work.  Don’t ask me, “Why?”

40 Principles of Parenting*

There are hundreds of books offering advice to parents.  The books range from the very straight-forward to the very philosophic.  Some provide a general overview of parenting. Others are written about children with specific challenges. Some are practical how-to books.  Others tend to focus on the parent-child relationship.  There are so many books because there are so many parents asking questions and there is no one right answer.  When it comes to raising children, there is little scientific consensus.  There is mostly opinion.

I taught a course on parent guidance to young doctors.  In this course we reviewed many parenting books, good and bad.  Though each author had a unique perspective and opinion to offer, there were themes, ideas about ‘good parenting’, that seemed to reoccur through many of the books.  From this, my class distilled 40 principles of good parenting.

This is likely the longest blog I’ll ever write, but it’s far shorter than the book I had intended to write.  I once thought I would write a book based on these 40 principles.  Well, here are those principles, given to you in their bare form, without the commentary or illustrative examples that I would have included in my book. Yet, for those of you who are parents, I hope you find this list helpful.  Feel free to delete from the list any principles with which you disagree.  Please add to the list any additional principles you’ve discovered and embraced in your parenting journey:

Principle I:  Parents must provide children with the basics; food, shelter, medical care, and a safe/protected environment.  All other principles are secondary and contingent upon this first.

Principle II:  Parents should provide leadership.  Good leadership is calm and confident.  Leadership remains so even in the face of challenge and crisis.  When parents scream, threaten, nag, or hit, credible leadership has been lost.

Principle III:  Parents should model what they teach.  Model character.  Model willingness to change.  I have heard it said, “If you don’t model what you teach, you’re teaching something else.”  Parents model for their children ‘how to be’, how life is meant to be lived.

Principle IV:  Parents should raise adults.  It is the task of parenting to prepare children to become independent.  Give your children the opportunity to develop skills that will lead to competence.

Principle V:  Parents should avoid, when possible, win/lose battles with their children. Children who win these battles become insufferable.  Children who lose these battles become sullen and resentful.  Parenting is not a contest of wills.  It is a journey of parent and child together.

Principle VI:  Parents should remember to use the wise words, “go play” with their children. In other words: turn off the screens go outside, go exercise, go use your imagination.  Go find the resources within yourself to be entertained, to wonder, and to explore.

Principle VII:  Parents should raise children with encouragement.  Parents must convey a belief in their children’s capacity to learn, to grow, and to accomplish.  Parents must discipline with a tone of encouragement, "I know you can do better."  Parents must find ample occasions in which to give praise.

Principle VIII:  Parents should strive for consistency.  Parents are human.  There will always be good days and bad.  There will always be situations better handled or poorly handled.  Consistency means that despite the everyday ups and downs, there remains a consistent set of beliefs and guiding principles.

Principle IX:  Parents should be flexible and creative.  Different situations, different circumstances, different ages may require different responses.  What works with one child may not work with another.  What works at one age may not work at another. A common error is to keep trying to do what has already been proven not to work.

Principle X:  Parents should talk to their children about being part of a family. Families are interdependent systems.  Parents lead the family, but like the engine of a car, there are big parts and little parts. For the engine to run properly, each part must do its job.  A family relies upon one another, and every job is important to the function of the family.

Principle XI:  Parents should respect and value their children.  Children are not property or baggage.  Treat children not as ‘its’ but as ‘Thou’s.’

Principle XII:  Parents should attend to their children’s character.  Make ‘being good’ more important than ‘being happy’.

Principle XIII:  Parents should provide their children with a moral compass; begin with the Golden Rule, “do unto others.”  A religious parent can teach a child the moral precepts of the faith.  A secular parent can teach a child the principles and morals that guide the family.

Principle XIV:  Parents should make rules and expectations that are simple and clear.  Plan and discuss rules, expectations, and consequences in advance.  Set age-appropriate limits.  Encourage children to participate in the planning.

Principle XV:  Parents should make consequences proportionate to the misdeed.  When possible, allow natural consequences to follow.  When necessary, make consequences follow logically from the misdeed.

Principle XVI:  Parents should negotiate with their children, increased privileges for increased responsibility.

Principle XVII:  Parents should avoid too much talk and negotiation when implementing consequences.  Implement consequences calmly and firmly.

Principle XVIII:  Parents should utilize time-outs for both children and themselves.  This is a time to cool off, to think and to reflect.  Rather than lash out, rather than let your amygdala do the talking, say to a child, “I need time to get my thoughts together”, “I’m too angry to speak right now”, “I don’t want to say something now I’ll regret later”.  Don’t react. Don’t try to reason with a child who is in an unreasonable frame of mind.  Talk will usually escalate the situation.  Wait until everyone has cooled off.

Principle XIX:  Parents should turn mistakes and misdeeds into learning opportunities.  It is far more important that children learn from mistakes rather than how children are punished for mistakes.  Discipline, as in the word disciple, means to learn.

Principle XX:  Parents should make their children not just the problem, but participants in the solution.

Principle XXI:  Parents should, when possible, give choices, not ultimatums.

Principle XXII:  Parents should model good communication with their children.  They must be fully present.  Put down the electronics.  Make eye contact. Speak to children at their eye level.

Principle XXIII:  Parents should acknowledge with empathy their children’s challenges but remind their children consistently that challenges are different from excuses.

Principle XXIV:  Parents should encourage their children to do even better, but not so much as to lead to excessive frustration and failure.  Teach children that challenges are not to be avoided.  Challenges are there to accept and embrace.

Principle XXV:  Parents should avoid the overuse of bribes.  This includes star charts, stickers, and other forms of ‘rewards for good behavior’.  Avoid raising children who automatically ask, “what’s in it for me?’

Principle XXVI:  Parents should discipline. Discipline is different than punishment.  If a child sets out to learn to play a musical instrument, discipline means practicing 15-minutes every day.  It may be boring.  The music may not sound good at first.  Scales are no fun.  But if you stick with it, the music begins to sound better.  Stick with it over time and you may become a musician.  Punishment is “you’re grounded for not practicing.”  How many times you’re grounded matters little.  Whether you had the discipline to practice is what will count in the long term.

Principle XXVII:  Parents should be forgiving of their children and of themselves.  We are all imperfect.  We all struggle.  Most times we and our children do the best we can.

Principle XXVIII:  Parents should be ready to ‘coach’.  A coach teaches skills, and a coach is a motivator.  Coaches come up with game plans, but it’s the players that must execute the plays. When you play games with your children, compete less, coach more.

Principle XXIX:  Parents should encourage their children to set goals.  Help children to have a vision not only of what they want to be, but who they want to be.

Principle XXX:  Parents should not do for their children what their children are able to do for themselves.

Principle XXXI:  Parents should teach children to observe and respect personal boundaries.  Parents are entitled to their privacy. Model and teach age-appropriate modesty and privacy.

Principle XXXII:  Parents should value and support education and learning.  Encourage curiosity.  Encourage reading.  Encourage exploring.  Encourage outings to museums or the library.  Provide an environment conducive to homework and study.  School is a child’s primary job.

Principle XXXIII:  Parents should respect the power of words to hurt or to heal.  Labels matter.  When possible, find the positive label for children.  To label children ‘determined’ or ‘strong-willed’ is preferable to ‘defiant’ or ‘oppositional’.

Principle XXXIV:  Parents should encourage the use of words.  Children who can talk out a problem are less apt to act out.  Read to your children.  Have conversations with them.  Teach them to express their thoughts, their ideas, their feelings, and their beliefs.

Principle XXXV:  Parents should teach children manners, how to say ‘please’.  Teach children gratitude, how to feel thankful.  Teach children to be givers rather than takers.  Teach sharing, generosity, and social responsibility.

Principle XXXVI:  Parents should guide children towards role-models.  Help children to distinguish a role-model from a celebrity, a hero from an idol.

Principle XXXVII:  Parents should give their children the gift of a family narrative: the history of the generations, the culture, the religion, and the associated values.

Principle XXXVIII:  Parents should ‘remember when’.  You were once that age.  Empathize with your child’s developmental challenges.

Principle XXXIX:  Parents should remember to hug, to kiss, and to say, “I love you.”  These are powerful antidotes to sadness, discouragement and anger.

Principle XL:  Find the joy in parenting.  It is hard work.  It is a 24/7 job.  But children can be a great blessing.  “For to miss the joy is to miss all.”  (R.L. Stevenson)

 

*an abridged version can be found on the blog from Jan. 7, 2019

The Unknowable

“As we acquire more knowledge, things do not become more comprehensible, but more mysterious.”  (Albert Schweitzer, 1875—1965)

Once, humans looked at lightening with awe and without understanding.  Maybe they thought that lightening was sent down from the heavens by the gods.  Now, we understand lightening as a natural phenomenon.  Much of what once had no explanation, is now easily explained.  As a result, there are many who believe that nothing is beyond the limits of our understanding.  They believe that some things are yet to be explained, but someday we will be able to do so.

I believe otherwise.  There are limits to what we can ever know.  A dog can only know what a dog’s brain allows a dog to know.  No amount of teaching will open a dog’s mind to the world of math, or music, or literature.  (But then again, no amount of sniffing will allow me to know the dog’s world of scents.) Similarly, a human can only know what a human’s brain allows a human to know.  Maybe, the universe is far more complex and mysterious than I am wired to fully understand. Maybe there is an unknowable realm that exists beyond the human brain’s capacity to ever understand.

I am fascinated by the truism that whenever one question is answered, ten more questions take its place. During my professional career, few discoveries led to any definitive answers to complex problems.  Most discoveries lead to the realization that many problems are far more complex than we ever really imagined, and the solutions to those problems remain frustratingly elusive.

Bear with me, and try to visualize an x,y-axis with a horizontal line drawn near the top.  On the graph, picture a curve slowly climbing towards that horizontal line, approaching it asymptotically, getting closer and closer but never crossing, never even touching, the horizontal line.

The ascending curve represents the extension of human knowledge over time. Under the curve is the sum of human knowledge.  Above the curve is the unknown.  Above the horizontal line is the realm of the unknowable.

No matter how far we progress in our knowledge, I believe that there is much that will always remain, for us, unknowable.  Will we ever be able to explain how mind and sentience emerge out of inorganic matter?  Defying description and all rules of cause-and-effect, will we ever be able to explain what is free-will (and I do believe there is such a thing)? Is it possible, even likely, that there exists a mind, or minds, greater than the human mind, in that realm of the unknowable?

The realm of the unknowable is the realm of maybes.  Maybe, within that realm, is a source of creative energy.  Maybe, within that realm, is a source of moral valence, right and wrong.  Maybe, from the realm of the unknowable emerge strands that temporarily connect that realm to ours, leading to what we call mystic experiences, precognition, revelations, or God-moments. 

I am agnostic.  I don’t know.  I live with maybes.

My Story

“The tendency of the human mind to see everything connectedly is so strong that in memory it unwittingly fills in any lack of coherence. . .”  (Sigmund Freud, 1856—1939)

“It’s cloud illusions, I recall . . .”  (Joni Mitchell, 1943--) 

I have an internal narrative, a story I tell myself, about myself.  My story is built upon memories.  However, over a lifetime I recall only bits and pieces.  I forget much.  I remember best the unusual out-of-the-ordinary occurrences.  I occasionally recall seemingly random and otherwise trivial memories. I often forget the everyday occurrences of my growing-up. 

There is bias in my recall. The memorabilia, the photos and the papers I hold on to, that I use to reminisce, have been kept and stored over the years because they are flattering or they bring to mind select special moments.

I remember best that which is most compatible with my self-narrative.  I likely filter and discard those memories that might refute my self-perception.

And, the story I tell myself, about myself, is different from a story about me as it would be told by my wife, or children, or friends. Whose story would be closer to the Truth, if there even is such a thing?

From the Oracle at Delphi we’re told, “know thyself.”  From Socrates we’re told that the unexamined life is not worth living.  If true, I must examine my self-narrative with a critical eye, asking a series of important questions.  First, how consistent is my self-narrative and how accurate am I with my facts?  Where might my recollections be distorted?  What has been over-emphasized, made bigger than it was at the time?  What of importance has been glossed over? To what degree have I over-emphasized the unusual and neglected the day-to-day?  I must not only examine the contents of my narrative, but I must ask what have I omitted from the story.  What have I ignored? What have I forgotten? Why have I forgotten?

I need to examine closely my explanatory biases.  How do I explain what I do and why I do it?  To what do I attribute causality?  To nature?  To nurture?  To chance and circumstance?  To my free-will and the choices I have made?

For those of you who, like me, have a self-narrative, we do so because we are wired to do so.  We look at the night sky, see patterns in the stars and invent the constellations.  We look at the clouds and imagine them to be identifiable pictures.  In the same way, we look at the scattered fragments and memories of our lives and turn them into a comprehensible whole.  My internal narrative creates order in my life.  It’s an attempt to explain who I am and why I am.  My narrative fills in gaps where memory may be elusive.  My narrative attempts to construct a good story about a decent man, who tried to make a difference.

In its written form, a memoir, I hope my story will be remembered when I am no longer, if not as an autobiography, then as a work of historical fiction.

Go Play

“Play is really the work of childhood.”   (Fred Rogers, 1928-2003)

“Imagination is more important than knowledge.”  (Albert Einstein, 1879-1955)

“We don’t stop playing because we grow old; we grow old because we stop playing.”   (George Bernard Shaw, 1856-1950) 

Last summer, I sat for an hour watching my 4-year-old granddaughter play contentedly in her garden. She drew in the dirt with sticks.  She rearranged pebbles.  She sniffed herbs.  She closely examined worms and roly-polies.  All the while, she was talking to herself, inventing stories.  For the most part, she was engrossed in her own thoughts and imagination. I was careful not to interrupt.  Only once-in-a-while, she’d look back to make sure she knew where I was, and then she would return to her play.

While she played, I thought about what I was watching.  Professionally, I’m well versed regarding the importance of children’s play.  Play is essential for normal healthy development.  It is necessary for the development of gross and fine motor skills, for the development of language, for the development of attention, for the development of social skills, for the development of affective regulation, and for the development of cognition and imagination.

When I was young, I remember my mother telling me, “Go play.”  In other words, turn off the television, and find something else to do.  I’m sure there were times when “go play” felt dismissive, my mother wanting me to get out from under foot.  Only as a parent, and now as a grandparent, do I appreciate the wisdom of those two little words, words that say so much more.  Turn off the screens.  Go outside. Go exercise.  Go use your imagination.  Go find the resources within yourself to be amused, to be entertained, to wonder, and to explore.

I don’t suspect my mother was fully aware of the developmental importance of those two words.  But, then, a good deal of parental wisdom is instinctual. Play, too, is instinctual. Nobody had to teach my granddaughter how to play in the dirt. She just knew to do it.

When my granddaughter played in the garden, she did so with no self-consciousness, and with no concern for time.  Her play was pure process, having no obvious objective. I was there in the background watching and monitoring her safety. Otherwise, the rules and limits of her play were hers to imagine and invent.

I, too, sometimes play.  I play chess and poker.  I play Wordle and other word games. I play guitar.  I play pickleball and golf (poorly).  Fishing is my play.  Writing is my play. For all the ways that I play, my play is very unlike my granddaughters, certainly far less spontaneous and far less imaginative, often regulated by conventional rules, and almost always having a measurable outcome.

The purpose of play in young children is developmental mastery.  But what is the purpose of play in a senior like myself?  Does it help me cognitively?  Does it benefit me physically?  Is it good for me emotionally?  I assume the answer to each of these questions is yes.  Therefore, when I’m sitting too long in front of a screen, or otherwise not knowing what to do with myself, I need to remember, “Go play.”