Tuesday, February 9, 2010

Doing well, but could be better

When we sit down to dinner as a family, Chris has very little to contribute to the conversation. Alex, his younger brother by two years, usually has a great deal to say about his new job or what's happening in the world. Alex is living at home while he saves for graduate school. Chris's two younger brothers are reaching the milestones that we think are important for young men in their twenties - higher education and jobs are the primary ones. Chris left university after a year and a bit, not able to continue due to psychosis.

Yet, when I came home from work yesterday, Chris and Alex were carrying on an animated conversation in the kitchen as Chris prepared the chicken risotto. They seemed to find a common ground. Chris had taken it upon himself to haul out the Bachelor's Cookbook, pick up the missing ingredients at the store and get to work on producing an excellent meal. This was after going to his one university class in the afternoon.

Everyday Chris makes his bed so well that you could bounce a quarter off it and does any kitchen clean-up that didn't get done the night before. He sees his psychiatrist twice a week. He sees an occupational therapist once every two weeks. He sings in the church choir on Sundays and practices Thursday nights. He has voice lessons Thursday afternoon. He helps out around the church, fixing things, moving things or stuffing envelopes. He volunteers from time to time at the local soup kitchen.

It is puzzling, because despite the fact he is able to do all this, he does not have paid employment neither is he at university full time. He reads a great deal of intellectually challenging material, which is a huge relief after a two or three years when he was able to read nothing.

I wonder sometimes if he is a victim of low expectations, not ours but theirs, meaning the psychiatrist and the occupational therapist. I fought against the low expectations that I sensed were at the heart of the day program Chris was in for two years. Ian and I pushed him to audit classes at the local university when it was clear that the psychiatrists thought that this was too much. I don't think Chris would be as far as he is now if we had succumbed to low expectations in the beginning. But since Chris's relapse a year ago, we have stopped reminding him that he should be back at university full time or doing something meaningful with his life. I believe that our over-eagerness to get him out of the nest caused him to relapse.

He relapsed after he had been slowly and carefully weaned off his two medications. So, he is back on medications, which some maintain make it impossible for him to work or go to class. That is exactly why I wanted him off the medications in the first place. I thought he would never be able to make it on his own if he stayed with them.

The other day Chris mentioned that somebody suggested to him that he do some volunteer work. What were they thinking? Surely this wasn't the occupational therapist or the psychiatrist suggesting this. He is doing volunteer work, lots of it. It is paid work and a full-time occupation that is eluding him.

I am not as convinced as I once was that the medications are preventing him from doing things. I'm sure they do slow him down, but I don't think that's the whole picture of why he isn't fully back on track.

It is hard to be patient. I hope patience isn't perceived as low expectations.


  1. It sounds like he is progressing very well. Maybe he simply needs a little time. It might be a worthwhile exercise to ask him to set some goals within the context of his vocational pursuits and evolving towards self sufficiency as a capable member of society developing and applying his full potential.

    My experience has been a compassionate push is sometimes necessary to move forward; delivered at an opportune time. Chris may be living in a world where he believes that he is destined for relapse and that his efforts will no doubt be met with failure. Well meaning psychiatrists, family, and other care providers, help create this limiting belief and this becomes the context the individual lives life within until it is interrupted by someone.

    How does Chris feel about his meds? Does he have a goal to get off them at some point? Does he feel he can function better with them for the foreseeable future?

    I have come to understand that with the support of a loving family and the ability to nurture an authentic relationship there that the affected individual in time will exceed your expectations. It's difficult to see this in the midst of a crisis or shortly afterward however something evolves within that safe nurturing environment that will have you saying somewhere down the road that it was all just a bad dream.

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  3. Thank you for these helpful suggestions. I will begin thinking about a compassionate push at an opportune time. I know Chris is wanting to get off or cut back on the meds, but he doesn't seem to be able to convince his psychiatrist of this. Perhaps he just needs to become stronger in his own convictions.

  4. I agree with anonymous. Just one thought: No matter what I engaged in and accomplished, it was never good enough, compared to what others engaged in and accomplished. - Brings Supertramp to mind, School: "And be like Johnnie - too-good, well don't you know he never shirks - he's coming along!" - I played the descant recorder: "That's not an instrument, it's a toy!" I used to go on hacks, bare-back, while others competed in dressage and show jumping (which in my eyes was utterly abusive towards the horses). I chose to "waste" my time and abilities on studying theatre theory, literature, philosophy... while I should have become a successful lawyer or doctor. And there certainly was no way that the daughter of a Hanseatic merchant and ship owner became a groom, mucking out at other people's stable. Voilà, that's exactly what I do today for a living, mucking out at someone else's stable. I'm happy with it.

    You compare Chris to his brothers. Chris is Chris. He'll find out what he wants to do with his life. And whatever he finds out, it'll be just as worthwhile as anything else. Whatever he chooses to spend his time and abilities on, it's worthwhile.

  5. It is more that I am comparing Chris to the milestones of young adulthood. As a parent, it can be pretty discouraging to have an adult child to support financially. If I didn't say this, I would be lying. I wouldn't be striking any notes with other parents who find themselves in this position, and getting older. Most people who write about mental illness do so from the perspective of the patient, not the parent. I doubt that Chris's brothers have given much thought to the possibility that they may indeed, have to be their brother's keeper one day. That is why it is so important for parents to do all they can to make sure their relative becomes well. This perspective is often lost but it is a real concern. I am very supportive of Chris's unique qualities, but eventually he's going to have to put them to good use, meaning he has to find a way to support himself financially. He is getting there.

  6. As a parent I can identify with your concerns. There were, and occassionally still are, times when I have felt that I would be saddled for life. Yes you do think about who may care for the adult child after you've departed this world or when you are no longer capable of doing so. And, I suggest that this motivation, inspired by fear, is not productive.

    Believing in your child, loving your child, and helping the child discover a pathway to a productive life are important. Not only do you need to overcome your own fears but you also need to help them overcome theirs as well. How can he possibly believe with conviction if he detects any weakness in the strength of your beliefs?

  7. Yes, I felt I needed to get over my own fear before I could help Chris because it doesn't help anyone, least of all Chris. Your comment highlights the quote from Harry Stack Sullivan under the Mother and Child painting in this blog. There is anxiety expressed as daily worry, and there is innate anxiety that I believe the unborn child picks up in the womb.

    Marian - am I going crazy or what? I received a very interesting comment from you and a link to Eckhardt Toll and now it's gone. I may have hit the delete button in my haste to get it approved and get back to what I was doing. My computer has been acting up today, but I hate to think I deleted it by mistake.

  8. Rossa: Here it is once more. Luckily, I usually copy-paste longer comments, so most of it, except for the last two and a half paragraphs that I typed directly into the comment box, I still have right here, ready to get copy-pasted again :) Basically I think, what I say in this comment is about the same as what Anonymous says above.

    I know what you mean. I should have added that the reason I was pushed (and ridiculed and demeaned for not living up to expectations) was that my mother was worried, and apart from being worried that I might turn out a "loser" socially, bringing shame on the family, she also was worried for me, my survival and well-being. Unfortunately, she never realized that it was all this worrying that kept me dependent on her, and, eventually, had me become afraid of myself and the world, and perceive myself unfit to survive on my own.

    I don't say that you worry in the same, pretentious way as my mother did. What I want to say is that worrying in itself is counter-productive, limiting. And it affects not only you, but also those you worry about.

    I came to think of Eckhart Tolle while writing the above, and had a quick look around the net. I found some truth about worrying (and expectations, high or low; worrying in a way is sort of an expression of low expectations).

    Expectations: Anyone suggesting the least expectations, if it was my therapist telling me that I shouldn't count on ever to be able to do this or that (low), or if it was someone just asking a favor of me ("high"), instantly had me get overwhelmed with anger. I've thought a lot about why, and I'm not sure that I've found the final answer. But it certainly has to do with me having felt limited in my own choices, my personal freedom, by others' expectations, no matter if they were high or low. And I so needed personal freedom and the opportunity to make my own choices in order to take responsibility for myself.

    Since then, I've come to understand that taking responsibility also means having to accept that others may have expectations, and that I have to take the consequences of my choices concerning these expectations. Just as I have to take the consequences (satisfaction or disappointment) whenever I have expectations. I also have come to understand that expectations only can limit me to the extent I allow them to limit me.

    It takes its time to get there. And I imagine, it takes some extra time when someone constantly is confronted with the system's low expectations. - And drugs, too, are an expression of low expectations, worries: "You'll relapse if you don't take them." It's like Peter Breggin says in "Take These Broken Wings", if you tell people they need the drugs, you tell them, they can't take responsibility for themselves, that they can't do on their own, that they're not fit to live an independent life in this world, and that they never will be able to.

  9. Marian....very insightful!

    I suggest that the expectation/ anger circle that you occupied was propogated from fear. Anger is a response to fear. Based on what you have written I get the impression that you felt you never quite measured up to your mother's expectations. As a consequence you may have had deep seated feelings of inadequacy and low self esteem and lived your life within a context of destined failure.

    Parents have a moral obligation to create a context for their children that allows them to view the world, and the animate and inanimate occupants of the world, as something they are connected and related to, something that holds possibility for them, something that allows them to discover and apply their full potential capability. The parent who focuses his or her attention predominantly on the gap between where you are and where he or she would like you to be inspires attitudes that become self defeating. The child does not appreciate that the parent may be well intentioned. The child hears "I am not good enough".

    It's entirely understandable why an individual would want to break with that reality and find an altered one. I don't believe I've heard of anyone who had auditory hallucinations that were supportive and nurturing. They are generally critical, demeaning, and judgmental of the individual who hears them. This should provide some indication of what is missing that would allow the affected individual to live a life of possibility versus no possibility.


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