They fuck you up, your mum and dad.
They may not mean to, but they do.
They fill you with the faults they had
And add some extra, just for you.But they were fucked up in their turn
By fools in old-style hats and coats,
Who half the time were soppy-stern
And half at one another’s throats.Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can,
And don’t have any kids yourself.- Philip Larkin
In our recent thread, On the Borderline, DeeDee Ramona made the comment that, “Sadly, from what I have seen, what would work best for a lot of young patients is a parent-ectomy.”
Let me introduce you to a prime example. He’s called David and he’s 14 years old.
We’ve been running an anger management group in the CAMHS clinic, and David has been referred to the group by one of the psychiatrists. David’s parents brought him to CAMHS, saying he’s causing chaos at home. He steals things, he blows his top for no apparent reason, he tries to manipulate his parents and drive wedges between them. David admits he has a problem controlling his anger, and says he “has an attitude problem”.
David joins the anger management group. He’s a good attender. Always polite, very helpful. Doesn’t come across as particularly angry, though one thing that does come across is that his self-esteem is at absolute rock-bottom. David says he wants to change and “be a better son”, though he’s never quite specific about in what way he’s supposed to be better.
Meanwhile, the psychiatrist has requested and received a school report. David’s behaviour in school is described as “excellent”, though the teacher writes to express concern that David seems very unhappy.
So, he’s not angry in the therapy group, and he’s apparently not angry in school either, so what’s different about home, since that’s where he does get angry?
Meanwhile, between the individual sessions with the psychiatrist and the group session in anger management, the parents’ depiction of David is starting to unravel. They say he’s stealing things in the home, but when pressed about what he’s “stealing”, it’s things like a can of coke from the fridge, or an apple from the fruit bowl. Is this stealing, or simply snacking? We press David on what sort of things cause him to become angry at home. He talks about his friends coming round to see him, and then his parents demeaning both David and his friends while they’re there. Or them berating him at length for not doing household chores that they hadn’t even asked him to do in the first place. And then he gets angry.
In other words, things that you or I would get angry about too.
But David doesn’t see it like that. He’s had it drilled into him that he’s the one with the problem. He’s the patient. He’s the source of all the difficulties in the family home.
RD Laing wrote about these kind of disturbing, distorted family patterns in Sanity, Madness and the Family, where one individual becomes declared the all-purpose generally-agreed patient/problem/scapegoat within the family network. I don’t agree with Laing’s suggestion that these patterns are the cause of schizophrenia, but they do form a hefty chunk of the people who come to CAMHS.
We’ve arranged some family therapy sessions for David and his parents, though the therapist will have to be bloody careful to make sure the parents don’t seem use the sessions as an hour in which to berate David some more.
We’ve also put in a referral for David to a local voluntary organisation that runs projects for troubled teenagers. Hopefully they’ll be able to help him to improve his self-esteem, develop a degree of independence and maybe help to change his view of the world and himself. Not quite a parent-ectomy, but it’s as much as can be offered.
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July 9, 2008 at 8:09 pm
Pingback from Mental Nurse / The Politics of the Family
May 18, 2008 at 8:52 pm
Azulinebloo
I remember being forced to understand Larkins poetry when I was at school. I hated it with a passion. I was sure the teacher chose this poem for the shock factor of using the F word.
I know appreciate the sentiment (or whatever it is that poems have) of the effect of parents.
In my child and adolescent placement I also spotted that 98% of problem kids boiled down to the dysfunctional parents/lack of parenting skills. Often the parents have their own issues and it’s sad watching it be passed down the generations.
May 18, 2008 at 11:58 pm
Cockroachcatcher
Nowadays it takes a very brave psychiatrist to say to the parents that the problem is not with the child. Then let them work out where the problem is. That way you did not actually say the problem is with them. David is showing the healthy side to react at home. We all should react to bad parenting, bad teaching and of course bad government. I have over my career seen too many really bad parents that no one will argue about and then I have seen those “bad” ones pretending to be “good” and doing the right and proper things. Those drive kids mad. Yes, mad. With packaging of CAMHS treatment and management, we now must appear to be doing something, CBT, Anger Mx, on top of family therapy, groups of different kinds and XXXX Rx and lose sight of the importance of identifying the real patient. Failing all of that, there is ADHD, ASD, ME and now a number of friend’s children as young as 6 has Bipolar and OD as parents are not contend with ADHD on its own and you now have a range of chemicals to pump into the child. At least a third of the children we saw were not the real patients. We could laugh at old USSR using psychiatry to control. We now forget we are doing the same in a different guise. Doing the right things especially according to guidelines and after team meetings will keep us out of trouble but where would that leave the patient?
I described my brushes with guidelines and parents in my book The Cockroach Catcher and you can read more extracts in:
Google Book Search.
May 19, 2008 at 12:14 am
zarathustra
At least a third of the children we saw were not the real patients.
Only a third? I’d put it higher than that in our clinic.
May 19, 2008 at 3:22 am
Cockroachcatcher
Just trying to be moderate. I remember it was such a problem once we have to start coding them. then what about those you continue to see although there was nothing wrong with them but you have formed some sort of alliance. A kind of mentoring. They pretend to be patients and you pretend to be their psychiatrist. If we are looking at the ones seen at CAMHS continuing on as Adult Mental Health Patients (Oooops the naughty P word), the numbers are amazingly low. Did we do a good job or was there something not quite right. There are the true psychotics, I grant you those. The other group that turns up early on the adult wards are the severely sexually abused presenting with a whole range of psychiatric diagnosis. Glad you noticed the one third rule—opens up debate.
May 19, 2008 at 6:59 am
leymoo
Hello. Oh dear. That looks like my childhood. That said, a lot of parents would consider an intervention into that sort of parenting “political correctness” gone mad or somesuch.
That said, my parents never would have sought a psychiatrist - they blamed *me*, which means I couldn’t possibly be ill - only selfish, lazy, a thief, a glutton and other such things. So it might be that a lot of kids in this situation don’t even end up in CAHMS.
Nothing I did at school seemed to matter. (I did eventually flip out and hide for days on end in the woods by about 15 or so and it escalated, spray painted my walls, suicide attempts that I hid etc). Add on top a drug dealing stepfather who set up arguments against me so it would detract attention from him… (bringing me and my bro down to spit in the milk to say we couldn’t have it because we were drinking too much milk, hiding toilet rolls, banging on the door yelling if you spent over 5 minutes in the loo - i had menstrual issues as well) Erm, yeah. My brother managed to escape it all as he was diagnosed with Aspergers at school so he was special and never did anything wrong intentionally, and then got to go to a residential school.
I instead ended up as a patient as an adult. You could argue a lot of us end up there eventually ^_^
I was merely overly anxious (and was below average in the social skills) until I flipped out.
I used to babysit some kids in my block when I grew up and I who was one of 4 children. He ended up the blame for everything as he was a bit hyperactive and wasn’t amazingly concerned about how people perceived him (unlike the rest of the family). When a teacher finally said that he was 1. well behaved and 2. smart it took them some time to adjust, and they never really did: he was just told off for “acting out” at home when he did “just fine” at school: usually shouting, shrieking, swearing at the kid. They also continued to attack his handwriting and his “poor” English skills (overall, he was about average). I don’t know what happened to him as I moved away, but at a guess he probably doesn’t have someone teaching him maths at a level usually for kids 4 years older than him. He’s most likely given up.
(I am aware the plural of anecdote is not data, but I like illustrations)
Kids fit the role they’re given to a certain extent, subconsciously etc. If they’re told they’re bad constantly they’ll start to think “ok, I’m bad” and then not see it as a problem to do bad things.
There are also many many children with much worse issues than just the above… and again, they’ll probably never turn up in CAHMS, or social services, or anywhere that may help. It’s very sad.
May 19, 2008 at 8:19 am
beakie
I like the poetry. Larkin is my hero. However, here is Adrian Mitchell’s rejoinder, with a far more positive view of parenting: -
They tuck you up, your Mum and Dad
They read you Peter Rabbit, too.
They give you all the treats they had
And add some extra, just for you.
They were tucked up when they were small,
(Pink perfume, blue tobacco-smoke),
By those whose kiss healed any fall,
Whose laughter doubled any joke.
Man hands on happiness to man.
It deepens like a coastal shelf.
So love your parents all you can
And have some cheerful kids yourself.
May 19, 2008 at 10:46 am
E
hah! they tuck you in your mum and dad, I like that.