The Mall

I only met the boy once.  I don’t even remember his name. But his story, I will never forget. I was a supervisor in a big-city child protection unit, so didn’t often meet the children being overseen by my staff of case managers. That was, unless there were problems and a special staff meeting was needed. That’s how I met this boy who was ten and who’d been in foster care since he was five. He was about to mess up his third placement.

His behavior problems were understandable. At age five, his mother had abandoned him at a local shopping mall. It’s beyond imagining, picturing this child, frantic as he searched the hallways for that one familiar person. He was originally placed in a transitional foster home, considered temporary until the court process slowly trudges its way to resolution.

The system had done all it could to locate the mother, a chronic drug user already known to us. It had been, so far, a fruitless process of searching for her or other relatives. By law, each month the system was required to launch an all-out effort by searching public records, running newspaper ads, visiting the last known residence and neighborhood. This would go on for his entire time in care.

Family reunification was always the top priority. But as time passed, the reality of him being returned to his mother faded and his permanency plan was changed to long term foster care. The facts around his abandonment were being handled with velvet gloves by his therapist. All he would say when asked was: “I got lost.” For a child of this age it is imperative to not push the facts upon him until he is emotionally ready to handle it. He had a long road ahead of him.

With his history and age, he’d already been designated unadoptable. He was in a special-needs foster home and that was probably where he’d remain until he aged out at eighteen. Of course, if his current behaviors continued, the system would have to move him to more and more restrictive placements. A group home was probably in his future.

I often shop and go to movies at this same mall. As I look down from the ascending escalator at the activity in this busy and bustling place, I can only imagine that terrible day. I wonder where this boy is and how his life has turned out. He’s an adult by now and I’m hoping he came to terms with this awful and unfair event and has made sense of his life. I hope against hope he has beat the odds by overcoming the dismal statistics so common common to foster children.

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Children Protecting a Mentally Ill Parent

July, 2016

The family systems dynamics of dealing with a mentally ill parent are on full display. That’s how and why Donald’s Trump’s high achieving children over compensate for their father’s acting out. They swoop in to protect him, trying to regain control, putting pressure on him to pick a sensible path.

What’s clear is that they’ve been doing this most of their lives. That’s why they’re so good at it. But it may not be enough in this highly charged world of national politics.

Early in the campaign season, I noticed his erratic behavior. There are now a multitude of examples all with an eerie sameness. On this particular night, he began his rally with a few pieces of paper in his hand. No doubt given to him by his campaign handlers hoping to keep him on track.

These talking points were, within minutes, thrown aside leading to his rambling from one topic to another. He never finished a complete sentence before galloping off to another subject with arms swinging wildly and voice wobbling. He’s imploding, I thought.

This was all too familiar. In my working life, I was a licensed social worker and therapist. I kept the DSM (the Diagnostic and Statistical Manual of Mental Disorders) on my desk or in a nearby bookshelf throughout my thirty–five year career. When a therapist, I always worked under the supervision of an MD or PhD for billing purposes and learned very well the long and complex road to diagnosing a personality disorder.

Please note that everything I’m saying about him is presumptive. There has been no diagnose of this individual and there probably won’t be. Personality disorders are especially difficult, both for the clinician and for the patient. Research is still out on the causes but studies point to a combination of genetics, childhood trauma or verbal abuse and negative peer influence.

A general definition of a personality disorder is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.”  What the textbooks call these “maladaptive behaviors” are deeply embedded into the personality of the individual.

Which explains why Trump seems stuck in a whirl of repetitive and unproductive behaviors. He knows no other way. Sees no other solution. Habitually reverting to old and time tested patterns of behavior have, let’s face it, rewarded him many times. Evidenced by his wealth.  And he’s not the only one. All you have to do is Google ”famous people with personality disorder.” You’ll be surprised. Or maybe not.

Very early in the campaign season, it wasn’t difficult to spot the obvious signs of his narcissism. Features of this personality disorder include: grandiosity, arrogance, lack of empathy, needing excessive attention, being exploitive, feeling entitled.

Add to that, the recent revelation by a journalist (Tony Schwartz, in New Yorker magazine) who is finally saying what he’d discovered. Schwartz followed Trump around for eighteen months then ghost wrote The Art of the Deal. As a result of getting to know him so well, Schwartz calls him a black hole, someone without a soul. I’m sure he isn’t trying to be poetic though his comments are sobering.

Schwartz goes on to call him a sociopath. This is an outdated term but its features are now found in the DSM’s diagnostic criteria for anti-social personality disorder. Those traits include: deceitfulness, impulsivity, lack of remorse, aggressiveness, and reckless disregard for the safety of self or others.

Here may be an individual with two full blown personality disorders.  And while his narcissistic features and his antisocial traits seem to be what we see day in and day out, there has been no definitive diagnosis. Which is why such silence from the psychiatric community. And there won’t and can’t be any official labeling until Trump enters into therapy.

The key to treatment for personality disorder is that the patient continues with the same therapist throughout so that these patterns can be fully analyzed and addressed. Its hard to imagine Trump admitting he might have a problem or might need some help in improving his communication or decision making?  That’s why personality disorders are so hard to treat and why the success rate is so low.

So don’t be surprised at the next spewing of hateful rhetoric, the next demonstration of lack of empathy or his angry diatribe about how he’s being mistreated. Trump will be acting the same way. Until election day. Now I’m the poet!

His campaign handlers will continue to justify his erratic behavior (“He was being sarcastic”).  His VP pick will be expected to “smooth out his edges” and rationalize his gaffs. His children will play out that very important role of the caretaker. News pundits will gleefully revel in the daily newsbytes that build their ratings. Hopefully, voters will come to understand what they’re dealing with before it’s too late.

 

My Worst Jobs

After my 1963 high school graduation, I’d worked for nearly a year at Giddings and Lewis Machine Tool in my home town of Fond du Lac, saving hard for my college future. I spent my work day assembling and soldering circuit boards.

Lay-offs due to budget cuts moved my relocation up a few months. I was excited to get to Oshkosh earlier than expected, happy to get away from my family and get started on my life. I began the job search but with no real skills or a work history, I was only able to get assembly-line factory jobs. It was 1964, the summer of my worst job. It was two jobs actually. This was followed by other bad jobs throughout my college years but these were the worst.

The first one was at Standard Coleman, making television tuners. After a few weeks I felt almost crippled from my blisters and stiff hands. For eight hours I had to pull down an electronic nail gun and punch a part into place. I will never forget the loud mouthed cigarette smoking broads who were my companions on the floor. Some had been there for years.

It was an education in real life to hear them complain in the most colorful language I’d ever encountered about the antics of worthless husbands or boyfriends and their hellion children. My own occasional hang overs didn’t help the situation; I was getting a head start, quickly making new friends and becoming acclimated to the wild and carefree college life. The metamorphoses from my work life to my private life was stark.

When I couldn’t stand the assembly line atmosphere anymore I looked for other work and thought the next horrible job would be better. At Miles Kimble, a printing company, I had to watch personalized Christmas cards coming off a printer and inspect them for accuracy and quality. Boring. And again, surrounded by long time employees, unhappy and hopeless.

What followed throughout my college years was a variety of not quite so awful but still dead end jobs. Store clerk. Waitress. Secretary. Work study clerk. These worst jobs taught me one of the most important lessons of my life. The value of a college education.

 

What Goes Around Comes Around

Everyone knows what the phrase “what goes around comes around” means. It usually involves that arrogant manager or that disloyal friend and our gratification when they finally get what’s coming to them. While we don’t often have the pleasure of seeing it come around, we know in our heart, sooner or later, it does.

I adjusted that phrase when I heard some good news and applied it to how an old idea can come around again in a good way. Maybe that’s the case of Michael Botticelli, recently named but not yet approved by Congress as Director of National Drug Control Policy.

He doesn’t want to be called a drug czar because that harkens back to the decades old War on Drugs and Nancy Reagan’s Just Say No program. That didn’t work, he says, and should be declared over. But he points out, we as a country cannot continue to crowd our jails and prisons with low level drug offenders; their lives are ruined with heavy convictions that make it near impossible for them to get a job, rent an apartment or even vote in the future.

Maybe the combination of over-crowded, expensive prisons and the fact that heroin abuse has reached epidemic proportions, invading all stratospheres of society will make us finally consider another approach. In the long run money spent on treatment and in helping offenders take a new path in life would be more cost effective. At the risk of being labeled a soft hearted liberal I agree with Botticelli and am reminded of my past working in the addiction field.

The recent 60 Minutes segment on Botticelli transported me back to 1983 when I worked in Michigan’s Upper Peninsula. The small hospital housed an AODA (alcohol and other drug addiction) inpatient program using the 12 step model of Alcoholics Anonymous. That was the good old days when drug and alcohol use was considered a disease. At least, the recovering community called it a disease though this concept was denigrated by the general public. Most recently, this has fallen by the wayside as we’ve ramped up the punishment of drug offenders. Substance abusers are now seen only as criminals. And yes, they’ve broken laws but there is much more to the story.

I also say the good old days because back then the treatment community was such a closed network. In order to become an AODA counselor all that was necessary was to have gone through treatment (30 days inpatient) and to be recovering and working a program. I had done neither but fell into the job when my limited hospital social work duties left me time to be helpful in the treatment program. But I was surrounded by suspicion because I didn’t stand up and say I was an alcoholic or an addict and I was the only staff with a college degree.

Daily, I co-facilitated group therapy, beginning with each group member introducing and labeling themselves. Hi. My name is Mary and I’m an alcoholic. Naming it was a necessary way to beat denial. One day, someone asked why I didn’t follow suit. I explained my non-recovering status and then lightened it up with a joke: Hi I’m Karin. I’m a paranoid schizophrenic with narcissist tendencies. We all laughed, I was accepted and we got back to business.

Staff always had lunch together and one day the Medical Director joined us. During our shop talk he said he thought everyone should be abstaining from something. This was the basis of AA, he said. I knew he was speaking specifically to me. I was young and cocky back then and jokingly said I was abstaining from being rich. My comment was not appreciated.

This MD was of the school that believed once you stop drinking all the other problems are fixed too. I’m from the school of co-morbidity, the simultaneous presence of two conditions in the same person. That’s addiction joined with the mental health and just plain difficult life issues that originally led a person to find comfort in drugs and alcohol. For true recovery, it all needs to be addressed.

I’d become friends with one of the counselors who seemed to have some loyalty concerns. She almost guiltily told me I was her first and only non-recovering friend. She also felt she was betraying someone or something by considering any treatment other than AA meetings. But from our many hours of case consultation following group therapy she began to see the connection between addiction and mental health. And also the complexity of changing every aspect of life in recovery.

I came away from that long ago experience with a good understanding of addiction and a respect for the Twelve Step philosophy. Addiction is a chronic illness and needs to be treated as such and that’s hard in our cure oriented world. So, it was with relief I heard the news from Botticelli, backed up by scientific studies that prove how drugs affect the brain. The science supports that addiction needs to be treated not as a criminal matter but as the public health issue that it is.

This is currently close to me since I have a friend whose child is struggling with addiction. After being in and out of jail, my friend’s young adult child has been given the choice of jail time or intensive treatment. This makes me hopeful. Perhaps Botticelli, in AA himself for over twenty years, can return us to sensible and effective results. But will taxpayers and legislators support money spent on long term benefits over short term solutions?

Two weeks later, 60 Minutes read their viewer’s responses to the program. Comments ranged from simplistic to negative. Maybe what goes around hasn’t really come around after all. It’s one thing to have these innovative ideas but quite another to carry them through with our contentious legislature and a doubtful public. I wish Mr. Botticelli my very best. He’s going to need it!

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