Challenged

Many years ago, I met someone who was born deaf.  “Deaf” was the term of choice back then.  The hearing loss was profound and probably due to complications from maternal rubella.  Nevertheless, this person had learned to speak fluently and confidently.  And, she had graduated valedictorian, at the top of her professional class.

I had the opportunity to talk to her mother and ask how she had taught her daughter to speak.  Her mother first told me about the older and unimpaired sibling.  “With our first child, we had to repeat a sound four or five times.  With each repetition he took in more information, until he could accurately repeat what he had heard.”

“With our younger daughter it was different.  First, we had to recognize that something was wrong.  Once the proper diagnosis was made, we had to get her fit with the best hearing aids available.  Even with that, she had only one or two percent of normal hearing.  Then came the hard work.”

“Instead of repeating sounds five or six times, we had to repeat sounds 50 or 60 times.  But, if we did this enough, if we persevered, she too got enough information in to be able to imitate and repeat our words.”

This story is filled with important lessons that I shared with many patients and parents.  First, a problem must be recognized and acknowledged, then followed by a thorough evaluation.  Proper treatment begins after an accurate diagnosis is made.

I compared the hearing aid to medication.  The hearing aid was not a cure.  Often, neither is medicine, especially when prescribed for conditions like ADHD.  The hearing aid created a window of opportunity, an increased receptivity to sound.  It made learning sounds possible.  Like the hearing aid, ADHD medication is prescribed in order to create an increased opportunity for learning. If medication allows more information to get in, more efficiently, then more learning is possible.

I reminded parents that the hearing aid did not make the hearing perfect, but it helped.  Medication does not make things perfect, but often it helps.

I pointed out that had the mother tried to teach speech without the use of a hearing aid, all the hard work would have been for nothing.  But if there had only been the hearing aid, and not all the hard work and diligent teaching, nothing would have been gained.   I cautioned parents that medication is not the end point, only a beginning.  The hard work of diligent parenting and teaching must follow.

I encouraged patients and parents to remember that this young girl’s deafness was a daunting challenge, but it was never allowed to become her excuse.

November 22nd, 1963

November 22^nd,1963, my tenth birthday, was marked by two great occurrences, one of great historical significance, one of great personal significance. 

It was lunch hour at school.  I’d finished eating and was outside for recess.  My friend Paul lived nearby.  He’d gone home for lunch.  When he got back to school, he immediately looked for me on the playground.  He told me that President Kennedy had been shot. My initial reaction was disbelief. I told Paul that I didn’t appreciate his humor, especially on my birthday.  However, I soon realized he was not joking. Something serious had happened.  We returned to class.  The teacher was in tears.  A black and white television was set up for us to watch.  We heard that President Kennedy was dead.  We continued to watch the news quietly, until it was time to go home. 

If I recall correctly, this took place on a Friday afternoon.  I am told that memory is quite unreliable, yet my recollections from that day feel very real to me. 

I got home.  Our television set was on.  A birthday celebration had been planned, but my parents were unsure what to do.  We ended up going out for a birthday dinner.  I remember the restaurant being very quiet, the employees and customers very somber. A television set was on for all to watch.  After dinner, there was a muted celebration. Relatives came to the house, presents were opened, and birthday cake was served. 

The day Kennedy was assassinated marked the end of “Camelot”, a period of national optimism and innocence.  What followed was the tumult that characterized the remainder of the ‘60’s. 

November 22^nd, 1963 was also the day my parents gave me a microscope.  It was not a plastic toy microscope.  It was a Swift student microscope, the kind used in the high schools.  It came in a heavy locked wooden cabinet.  It was anchored to the cabinet by a bolt, so it couldn’t slide around and get damaged in transport.  It had built in illumination and could magnify up to 600X. 

Over the next months and years, I built a small laboratory in the basement.  I did some primitive dissections, mostly on insects and worms.  From my specimens I prepared some primitive slides.  However, my favorite ‘experiment’ was examining drops of pond water under the microscope to see otherwise unseen creatures; daphnia, paramecium, and amoeba. 

Around then, I read Microbe Hunters by Paul De Kruif.  I learned about Louis Pasteur and Robert Koch, scientists who used the microscope to discover killer bacteria, heroic discoveries that subsequently led to cures and the saving of countless lives.  These famous scientists became my inspiration.  As it turned out, the day I got my microscope marked the beginning of a personal journey, culminating in my medical degree. 

November 22^nd, 1963, was my tenth birthday. It was a day of great historical significance.  And it was a day of great personal significance.  I remember that day well.

Discipline

“True freedom is impossible without a mind made free by discipline.”  Mortimer Adler (1902—2001)

When children and adolescents came to the office with out-of-control behavior, it was rarely for lack of punishment.  Many had accumulated years and years of punishments.  They’d been spanked, grounded, and yelled at.  They’d lost privileges and had possessions taken away.  Some had even been to court, in juvenile detention or on probation.  Most of these youngsters were over-punished and all were under-disciplined.

Mistakenly, impulse-ridden acting-out children are often labelled ‘willful’ whereas it would be more accurate to label them ‘will-less.’  They are not making ‘bad choices.’  There is no act of decision making.  Without self-discipline they don’t stop to think and choose.  They react.  Like tapping on a knee, their behavior is reflexive, not reflective.

It is important to know the difference between discipline and punishment.  Discipline comes from the Latin root ‘Discipulus’ meaning pupil.  Discipline is process of teaching that emphasizes hard work, the practice of good habits over time, setting long-term goals, and accepting delayed gratification.

Take for example a child learning to play a musical instrument.  Discipline is the 15 or 20 minutes spent practicing every day, even when they’d rather being doing something else, even when it feels boring or hard.  It may feel like punishment, but it’s not.  At first the music sounds clunky.  Scales are no fun.  But stick with it for a few months and they begin to play some melodies.  Stick with it for a few years and they begin to play and create beautiful music.

Punishment is getting yelled at or grounded for not practicing.  Punishment gets you no closer to the goal of mastery.  Practice does.  Inevitably a parent asks, “What do I do if my child refuses to practice.”  I reply, as in the movie Apollo 13, “Failure is not an option.”  “If your expectations are clear, your child will practice.”  (By the way, it is estimated that 1,200 hours of practice are needed to become 'good' on the violin.  6,000 to 8,000 hours of practice are needed to become a concert violinist.)

There are important keys to raising a disciplined child.  It takes a caring and committed parent, willing to instruct and to model.  The parent must teach the value of delayed gratification and help their child to set long-term goals.  The parent must motivate, conveying the belief in their child’s capacity for ultimate success. 

Disciplined, a child learns to postpone immediate gratification for more distant goals.  Disciplined, a child acquires the self-confidence that comes from hard work and achievement. Disciplined, a child grows prepared to assume adult responsibilities to family and to community.  Disciplined, a child is prepared to face life’s trials and challenges with courage and with character.

The Giving Tree

A popular children’s story begins, “Once there was a tree and she loved a little boy.”  When I first read The Giving Tree by Shel Silverstein, I didn’t understand its wide appeal.  I thought it was an awful story about a self-centered child and a tree who couldn’t say ‘no.’  I thought that the story might as well have been titled The Taking Boy.  The tree gave without restraint, and without any expectation that the boy give back in return.  She gave until there was no more to give.  The boy initially loved the tree as a child might love his mother.  But as he grew, the tree became his object to use and exploit.  She freely gave, and he selfishly took her fruit, her branches and even her trunk.  He wasn’t concerned for the tree’s well-being.  He visited her only to ask for more.  He never said thank you.  He didn’t call on weekends.  He never brought his family over to visit.  Had the tree ever said no to the boy’s request, I believe that the boy would have left and never come back.

Over the years, as I’ve reread The Giving Tree, I’ve come to believe that there is a great deal of subtlety to the story, subtlety that I did not originally recognize.  If the story is heard as a charming parable of loving and giving, then I believe that the meaning is missed.  If it was intended as a children’s story, it is a children’s story without a happy ending.  The illustrations in the book are telling.  The pictures are sparse, lines drawn in black and white.  The little boy becomes an unhappy, withered and worn out old man.  The tree is reduced to nothing more than a stump to sit upon; nothing left to give, nothing left to offer to a new generation.

The Giving Tree is a classic best-selling children’s book.  What is its appeal?  Perhaps, each of us has wished at some time or another for a giving tree, a source that gives without end and that asks nothing of us in return.  The brilliance of the story is that it does not romanticize this fantasy.  Instead, Silverstein shows us the ultimate emptiness of mindless indulgence.  Some wishes are best left not granted.  Sometimes it is important for parents to set limits, for children to hear, “Enough!”  The story is as much for parents as it is for children. Who among us as parents wants to raise a taking child?