"On Healing" February 2004

Posted on Mon, Feb. 16, 2004
Presidents' Day good time to reflect on parents
By Dan Gottlieb

Presidents' Day. Sometime before or after we have shopped, we are supposed to think about those who founded or led our great country. Perhaps try to imagine their courage and foresight and realize how fortunate we are.

This might also be a good time to reflect on our personal founders: our parents, grandparents and great-grandparents.

Many of us could talk about grandparents who came over here on steamers, escaping lives of terrible economic or political adversity for the purpose of finding a better life for their families. Even slaves who were brought here against their will devoted their lives, generation after generation, to the pursuit of freedom and the protection of their children. What incredible courage and tenacity that must have taken.

Today, parents still devote themselves to trying to make life better for the next generation. The care for our children's future is clearly a biological imperative, not just a conscious choice. Of course, that imperative does not mean that parents will necessarily do a good job.

The great director Ingmar Bergman titled one of his autobiographical films Best Intentions, which described his family's motives. I'm sure the title could also describe the motives of most families. We come together with love, hope and best intentions.

And then life happens.

People, including parents, are genetically wired to act in certain ways under stress; relationships fracture, children sometimes make parents feel out of control. And sometimes innocent children get hurt. Some carry wounds silently, some drink or do drugs or starve themselves, and some come into offices such as mine.

Understandably, they complain about what did or did not happen to them. Then the emotions frequently come flooding in - anger or sadness or shame or loneliness, usually a combination of all of them. Many feel trapped by the injuries received from their parents. And many are.

But the prison is not built by our parents' behavior; it is built by our reaction. Rabbi Harold Kushner once said that resentment was like mud-wrestling with a pig: "You will both get dirty, but the pig will enjoy it."

Intentions, when parenting, are genetically driven. But how children react to their parents may not be. Some are able to honor the gifts that go with our parents' intentions, and some get lost in the injuries that may have come from our parents' behavior. And, in time, many are able to make the transition from getting lost to honoring the gifts.

Several years ago, I treated a woman whose childhood had included an alcoholic, unpredictable mother. This woman had looked to her father for protection, and because he didn't drink and was stable, she felt safe with him in her early years.

But as she grew, he became more withdrawn and angry. One evening when she was 16, her boyfriend dropped her off at the house 30 minutes past her curfew. Her father slapped her in the face, called her a tramp, and didn't talk to her for weeks.

She spent 20 years struggling with her sense of abandonment and rejection. Eventually, she was able to tolerate the hurt and spent a long time assuming he didn't love her. In time, as her defenses softened and she could tolerate more of her emotions, she came to understand that her pain was not because he didn't love her; it was because he didn't return the love she felt so deeply for him.

As father and daughter both grew older, she realized how difficult it had been for him to spend a lifetime with an alcoholic wife too sick to be a companion. She realized he had stayed in a painful marriage because of his loyalty to his wife and daughter. She grew to appreciate that he might not have been a very good father, but he did have the best intentions.

Letting go of resentment is one of the most difficult things we can do. But, after all, wouldn't we want our children to forgive our mistakes and understand our motives? Very few parents want to hurt their children. And few children want to carry a lifetime of resentment toward their parents.

And how do we make this transition? Whether or not they are alive, spend some time imagining your parents and their intentions when they were young people. Try to imagine their wishes and fears. And then try to imagine being free of resentment and feeling love and gratitude toward your parents. That would be a way to honor our founding mothers and fathers.

And if you don't do it well, that's OK. Remember, it's your intentions that count.

Posted on Mon, Feb. 02, 2004
Be cautious in diagnosing ADHD
By Dan Gottlieb

Many children with symptoms of attention deficit hyperactivity disorder (ADHD) actually suffer from a more prosaic malady: lack of sleep.

A recent study, published in the October issue of Pediatrics, examined more than 3,000 5-year-olds and found nearly 20 percent had symptoms of ADHD, while half reported daytime sleepiness.

Agitation and distractibility are not unusual symptoms for children who have not gotten enough sleep. It is quite possible many children medicated for ADHD are really sleep-deprived. When I discussed this on a recent radio show, I suggested that we should go slowly before we diagnose and medicate our children. The evaluation should be thorough and we should look at the overall context of the child's life, rather than simply medicate the symptoms.

In addition, I suggested that most of our children are overstimulated and that some of these hyperactive symptoms are just the response of their minds and bodies trying to keep up with an unhealthy environment.

One listener was distressed about what she heard. She wrote to me:

"My concern about what you were saying is that you may be encouraging children to be held hostage (by their symptoms) while you and others advocate for important societal changes that would probably work better than medication but are much harder to obtain than a diagnosis and medication."

I certainly agree that depression, anxiety, hyperactivity and rigid behaviors are illnesses that need to be treated. But they are also symptoms that need to be respected. Because if we respect the symptoms, rather than trying to eliminate them, they might lead us to the real problem.

Several years ago, I saw an 11-year-old girl for consultation. She had been diagnosed with school phobia as she would cry and argue with her parents every day before school. A behavioral therapist had treated her for her phobia but the treatment never worked. Her family doctor put her on medication for the phobia, but that didn't work either.

After a couple of sessions, she confided to me that she was being molested by an older boy at school who told her that if anyone found out he would hurt her. The phobia was the symptom, not the illness.

Family therapists have long known that a symptom in a child could also reflect a problem in the family. I have seen many children who showed symptoms of depression or anxiety when the real problem was parental conflict or depression. I was recently asked to see a boy who was agitated in school and diagnosed with ADHD. After I saw the family, it became clear that his mother had an eating disorder and the marriage was in trouble. As the family improved, he became less agitated.

This problem is not confined to children. Many adults go to their family doctor for stress-related symptoms or depression and get pills. Yet the real problem is with their lifestyle. So they get medication, which will suppress the symptoms so they can continue living a lifestyle that is unhealthy. Managed-care and pharmaceutical companies largely support this approach, as it is a profitable approach - in the short run. In the long run, the anxiety, depression or stress-related symptoms continue, resulting in lost work, medical problems and a variety of other social ills.

The classic example of treating symptoms is using diet programs for obesity. It is widely known that the failure rate for these programs is well over 90 percent, and any dietitian will tell you that what is required is a lifestyle change and not just a diet change.

Our children are increasingly diagnosed with ADHD, depression and anxiety disorders, and more children than ever are taking psychiatric medication. As a culture, we are becoming more effective at treating symptoms and less effective at treating the problems that cause them.

No, we cannot wait until our society changes. Society changes glacially and children suffer daily. But this ADHD business is a label upon which pharmaceutical companies have made millions, and parents and teachers are controlling overstimulated children chemically.

I am not waiting for society to change, but I am asking parents and professionals to take the time to look at the whole child and not simply to try to manage his or her behavior.

I also understand and respect the other side of the argument. I have seen how destructive ADHD is and what it takes away from children and families. And I have seen how medication can be a lifesaver when used with the right child in the right way. But to medicate a child (or anyone, for that matter) simply to control behavior does everyone a disservice.

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