Ich und Du

“However the history of the individual and that of the human race may diverge in other respects, they agree in this at least:  both signify a progressive increase of the It-world.”  (Martin Buber, 1878-1965)

Written in German, Ich und Du was published in 1923.  Translated into English in 1937, I and Thou became Martin Buber’s most recognized work.  On first reading, this short treatise is difficult to understand, and in places almost unreadable.  And yet, for me, the philosophy of I and Thou has become a profound and meaningful lens through which to observe and interpret the world. The lens of I and Thou offers clarity into the nature of the crises of our time. Buber’s philosophy of dialogue in I and Thou illuminates how we can and must respond.

Buber begins with a dichotomy, two modes of interaction, the I-It and the I-Thou. The I-It is by far the more common interaction.  When we interact with others as the means to an end, we typically interact in an I-It dialogue. For example, with a salesperson, we might exchange pleasantries.  Then the sale is made, and the interaction is over.  We move on with our day without concern about the person with whom we’ve just interacted.  Nor is that person likely to have a second thought about us.  In this day of burgeoning electronics, we really don’t even care if there is no salesperson with whom to interact.  We can buy online.  It was pointed out to me the irony that I.T. spells ‘it’.  Without doubt, the explosion of technology adds to our expanding It-world.

The I-it dialogue is impersonal.  The ‘I” is detached, thoughts directed elsewhere, watching the clock, bored, not really listening.  The “It” is objectified, not a person but a function, a type or a label.  Often the “I” wants something from the “It”, Often the “I” wants to be heard, but is unconcerned with hearing and responding to the concerns of the “It”.

In contrast, I-Thou interactions are characterized by presence. The “I” is fully present with one’s whole being, fully attentive, not only listening but hearing. The humanity of the “Thou” is acknowledged.  The uniqueness of the “Thou” is appreciated. The “I” interacts with no specific end in mind but with openness, curiosity and a wish to understand.

As a teacher, I invoke Buber’s I and Thou as a moral challenge to young doctors.  Is it still possible in this time of busy schedules and productivity quotas to maintain the I-Thou in a doctor-patient relationship?   My answer is yes, but only if it is undertaken as a priority and experienced as an ethical imperative.

Buber saw no less than the future of humanity at stake.  God, for Buber, is “the eternal Thou.” An expanding It-world leads to, what he called, “the eclipse of God.”  For Buber, godliness shines in the world when in the presence of the I and Thou.   Buber proclaimed hopefully, “The eclipse of the light of God is no extinction; even tomorrow that which has stepped in between may give way.”  The I-it may yet give way to the I-Thou.

With or without Buber’s belief in God, I think most would agree that we live in a frighteningly detached and impersonal It-world.  We fill our days with I-It interactions. Yet, the world needs more I-Thou dialogue; listening and hearing, being fully present, being curious, accepting, sharing and understanding.  The world suffers for lack of the I-Thou. Humanity yearns for the I-Thou.

Diagnosing Autism

“If you’ve met one person with autism, you’ve met one person with autism.” (Dr. Stephen Shore)

In the last years of my practice, I specialized in the diagnosis and treatment of autism. Of the many children brought to me for an evaluation only a small percentage were easily diagnosed.  The majority presented with some autistic-like findings but with other features that just did not fit the diagnosis. Rarely did I see a child present with the ‘full package’ of autism; language delays, social delays and rigid/repetitive behaviors. No two children I saw were ever alike. Each child came with a unique profile of strengths and challenges.

It was once hoped that scientists would discover a gene causing autism.  Instead, over 600 genes have been discovered that cause vulnerability to autism.  Furthermore, some of the same genes that cause vulnerability to autism also cause vulnerability to other neurodevelopmental conditions including, ADHD, language delays, fine motor delays, tic disorders and schizophrenia.  We now know that the genetics of autism is extraordinarily complex.

Add to this another layer of complexity, the new science of epigenetics.  Not only are there over 600 genes responsible for developmental vulnerability, there are hundreds of environmental influences that may turn on and off some of these genes.  It’s not only the genes that determine whether a child might develop autism.  It’s also the environment.

With all the combinations and permutations of over 600 genes, combined with countless environmental influences, it is understandable why each ‘autistic’ child is unique, one of a kind.  However, at times it was a challenge explaining this to parents who came to see me, just wanting a straightforward diagnosis.

‘Autism’ is no more than a label, which has served its purpose but, given current research, is becoming increasingly inadequate and anachronistic.  I predict that in the coming years, we will see the labels change, new diagnoses reflecting a more current level of knowledge.

Compared to when I started in practice, a great deal more is now known about autism and about genetics.  Sometimes, to know more is to find answers.  Sometimes, to know more is to realize how much more there is yet to discover and to understand.

Nature and Nurture

Back when I took Psychology 101, a much-discussed topic was the nature vs. nurture debate.  Theorists argued the extent to which development was influenced by genetic and biological factors (nature) versus the extent to which development was influenced by experience and education (nurture). Having watched my children grow, I am struck by the degree to which they are who they are by nature, less modified by nurture than I would have supposed.

From day one, my children came into the world different from one another.  Though offspring of the same parents, they had totally different temperaments and personalities.  One was by nature mellow, the other intense.  One wanted company, the other autonomy.  They slept differently.  On child you could kiss, hug or shake without disturbing sleep.  Touch the other child when sleeping, you’d get a swinging elbow and an accompanying groan of displeasure.

Emotionally, they were by nature different.  One was quick to show tears.  The other, unable to tolerate feeling sad, would instead get mad.  The discipline that worked for one was ineffective with the other.  Scold one and there were tears of remorse.  Scold the other and it was back-at-you.

Happily, both were funny and bright, but their styles of learning differed dramatically.  One was a sponge, eyes and ears open, information absorbed.  The other learned through active manipulation and mastery.  One child avoided any task that felt too hard, until age and development assured success, and then the task was quickly learned.  The other turned obstacles into challenges.  No problem was put aside until it was mastered.

Known to family therapists as “goodness of fit”, there are times when a child’s nature fits well with parental hopes and expectations.  There are times when it does not.  Sometimes there is a clash of child and parent temperament.  A quiet and cerebral child can be a difficult adjustment for parents who imagined a competitive and athletic child.  An active, exploring child can be a poor fit for parents more comfortable with quiet and order.  A strong-willed and independent child will struggle with parents who desire compliance and obedience.

It’s hard to nurture when natures clash.  Parents experience futility and disappointment when trying to make their child be who they are not.  There should be a parental version of the Hippocratic oath, “Above all else, do no harm.”  I would add to the oath a “lighten up” clause, a promise to maintain a sense of humor.

Through the years, my wife and I nurtured our children by providing a moral compass, discipline, and a safe environment in which to grow.  We have learned that by their nature, they are who they are.

I remember many years ago, when they were young.  One of my children, independent and creative, would not accept anything conventionally.  I tried to teach the rules for Go Fish.  Instead, my child insisted on inventing two alternative games, “Don’t Go Fish” and “Go Flush.”

My other child, social and good natured, came to me when learning the alphabet.  I was asked, “Daddy, what’s your favorite ‘F’ word?”  Unflappable psychiatrist that I was, I turned question into question.  “What’s your favorite ‘F’ word?”  “That’s easy . . .  Friend.”

Private Speech

“Thought is not merely expressed in words; it comes into existence through them.”   (Lev Vygotsky, 1896—1934)

I talk to others. I also talk to myself.  We all talk to ourselves. It is essential to thinking and reasoning that we do so.  This internal monologue, this “private speech,” mediates our attention, our learning, our behavior and our social interaction.  We use private speech to problem solve, to memorize, to categorize, to paraphrase, and to plan.

Much of what we know about the development of private speech, and the development of language in-general, comes from the research and theories of Lev Vygotsky.  Vygotsky was born in 1896 in Byelorussia to well-educated, middle-class Jewish parents.  Though formally educated in law, literature and philosophy, he taught and lectured in psychology. Despite suffering from tuberculosis, Vygotsky’s academic research and writings were prolific up until his death in 1934.  For many years thereafter, his work was largely unnoticed outside of the Soviet Union.  Only recently have his learning and language theories been widely studied, appreciated and applied.

Vygotsky recognized that language acquisition occurs best when a caring adult interacts with an inquiring child.  Optimally, language is learned in an interactive, language-rich environment, filled with stories, books and conversations.  Language is then rehearsed by the young child in the course of imaginary play, eventually becoming internalized as private speech.

Private speech is needed in order to interpret and store information in a meaningful way. Children with good private speech interpret silently what they hear and what they read.  They quietly paraphrase, and then can communicate the gist of what they have been asked to learn.  Children lacking a private voice cannot do so.

In the course of my career, I met many children who lacked use of private speech. Some of these children would problem solve, but their self-talk was out loud.  If asked by parents or teachers to be quiet, their problem solving ceased.  Other children I saw seemed not to use self-talk either silently our out loud. Often occurring with ADHD, these children faced significant academic, social and behavioral challenges. When spoken to, or when asked to read, they seemed unable to process information.  When questioned, they usually answered “I don’t know” or “I forget.”

Based on Vygotsky’s theories, I advised the parents of these children to create a language-rich environment at home in which private speech could yet develop. I suggested that parent and child read together, out loud.  I suggested stopping every so often to paraphrase and discuss what had been read. I advised parents to encourage their child to think out loud, this being a necessary step towards developing private speech. I stressed the importance of limiting electronics and engaging with one another daily in face-to-face conversations.

Unfortunately, children today spend less time interacting face-to-face with parents.  Children today spend less time in imaginary play.  There are less books being read, less stories being told and less conversations being had. Vygotsky understood the critical importance of parent-child interaction, the importance of adequate time for imaginary play and the importance of language acquisition, all essential for healthy development.  Vygotsky, long silenced and ignored, is now being clearly heard, informing us how children are supposed to learn.

The Answer to "Why?"

Many years ago, when my son was quite young, everything was, “Why?”.  I attempted to answer, but each answer was followed by another, “Why?”.  Finally, I found the answer that seemed to satisfy his curiosity.

“Daddy, why?”

“Jeffrey, economics.”