Tuesday, May 28, 2013

Guest Post: When Fathers Do Not Step Up - And Children Take over Their Roles

Today's guest post is by Allison Foster.  She recounts her own story, which describes the experience of someone who becomes what family therapists call a parental child.

In today’s society we hear a lot about fathers abandoning their families and children going crazy. It seems that what gets reported on the news is that such children live without limits, unable to be tamed by their mothers or other family members. But sometimes the child takes another route. After all, not all children rebel. 

Some “good kids” exist in the world who actually care about their siblings, their families and themselves. What happens when the fathers of those children decide to abandon their responsibilities? Well, that is what happened in my life, so I thought I would share my story.

It all started when I was very young - at birth you might even say. My biological father decided he did not want a family for real, so when my mother got pregnant he ran off to make his fortune. Six years later my mother remarried and the man she married adopted me. I cannot say that my father did not treat me just as he would his biological child. My little brother was born a year after their marriage and he always treated us both the same. That is not to say, however, that he treated either one of us well.

You see, my new father quickly found out he was not prepared for family life. He had been on his own since he was a teen, and the years he spent wild and free had not prepared him for the responsibilities of having a wife and children. My brother was a very needy child with many issues and my mother worked full time. My grandmother took care of us when we were not in school, but she came with many issues of her own.

As my father grew more and more overwhelmed with his responsibilities, he began to withdraw from the family. When he got home from work he considered his day to be over. He spent the evenings in his room fixed in front of the television or a computer. An obsessive personality, he would often get fixated on something, and our home played host to a collection of parrots, frogs, various computers, and so on. Needless to say he did not contribute much to the home besides more and more junk as well as his monthly paycheck.

Since I was seven years older than my brother and a responsible child, I was often his caretaker in the evenings when Grandma went home. My mother tried her best to do everything but she was overwhelmed by keeping up with the house, making dinner, and taking care of her own concerns. She was a very poor disciplinarian and could not seem to keep my brother, who had ADD and other issues, under control, so it fell to me.

I took over the role of father to my brother, becoming both disciplinarian and playmate. As we were isolated from other children where we lived, it was mostly just the two of us by ourselves. We fell into a type of rhythm. When he obeyed me by doing his homework or chores I would reward him with a game of catch or by taking him down to the creek to catch tadpoles.

I also took over the role of husband, in certain ways, to my mother. She needed someone to help her around the house with chores and meals, and that job fell to me. I worked alongside her as much as I could when my brother was playing happily in his room. I helped her to sort through bills and determine what needed to be paid. I helped her to get the lunches ready for school and pick out clothing for the next day. I made sure that the animals were fed and the doors were locked at night. I even helped her do yard work and install appliances when they broke down.

Things continued pretty much status quo for a while. I entered high school and discovered that the rest of the kids did not have to hurry home to take care of their siblings and help get dinner on the table. I found out that most kids did not have the responsibilities I had, and I began to resent my lot in life. Why did I have to make up for the things my parents did not do? Why was it my responsibility? I attempted to break free, a little at a time, but I always went back because guilt and worry ate at me. It did not seem right to abandon them, when they needed me so much. I looked forward to going away to college, secure in the knowledge that my brother would be eleven by then and old enough to take care of himself – at least to some extent.

Then in my senior year of high school things got worse. The summer before my senior year my father decided he had too much on his plate and ran away from home, just as my biological father had. After, of course, he had emptied our bank account to get himself settled in his new life.

My mother was distraught and beside herself. Not at losing him per se, but at the way he just ran away. She could not keep it together and began missing work. Just a month later she was on her way home from work and got into a serious car accident. She was in the hospital for almost two months and could not walk for a year and a half.

Boom! I was in charge of everything - from making decisions on which hospital she would be taken to, to figuring out how to make the house payment, and to feeding and clothing my brother and myself. I managed to get a part time job as part of my class schedule and worked from after lunch until around five. My grandmother moved in to take care of my mother during the day, but by the time I got home she was done and retreated to her room. However, her living there also meant I was in charge of her bills, food, and so on as well.

I was the head of a household comprised of an elderly woman, a disabled woman, and a rambunctious pre-teen. Overwhelmed does not even cover it. I did the best I could, although I am sure lots of things fell through the cracks. At seventeen most of us are not prepared to be tossed into the deep end of life. However I was doing pretty well on the meager money and resources we had to work with - until things got even worse.

My father lost his job. There went the small sum of child support. However, that was not the only issue. He lost his job because he went back to drugs, his downfall as a young person. I am not talking popping pills or smoking pot. Crack. The drug most likely to make you broke and crazy. I can’t say my father was a stupid man. He knew enough about my mother to hide the drug use from her when he came crawling back, begging to come back and become ‘part of the family’ again. What he really wanted was a place to crash while he smoked.

He knew my mother well. As I said before, she was a poor disciplinarian and could not say no to anyone. She let him come back despite my loud and ongoing protests. After all, I had all the responsibility but none of the authority. Oh, joy.

He took over the living room and built makeshift doors to create his own living area. Smoke continually poured out from beneath the doors, and I forbid my brother from ever entering that room. He, of course, wanted to be with his father and it took quite a while for him to wake up and realize that the man behind those doors wasn’t really a father any more.

Much to my regret now, I decided upon graduation to go away to college. I wanted to escape it all. I thought that by getting away I would force my mother to face up to her responsibilities and that she would get the guts to throw him out and pick up the pieces of her life. I spent nine months away, only coming back to visit on alternating weekends. It did not work. Every time I returned my mother looked worse, and I got the sinking feeling that I was missing more than I could see.

That summer after my freshman year in college I returned home, never to return to that faraway school. The family situation had further deteriorated. My father had yet to retain a steady job and turned to pawing various items of value in our home. He brought my mother, who was barely able to walk and needed a cane at all times, with him to the bowels of the city to pick up his drugs. At times she feared that he would sell her for his crack as well. She stayed with him out of some misguided belief that she could keep him safe. I can’t say that she did not try her best with him.

My brother was shell shocked and refused to come out of his room most of the time. His grades were barely above passing and he had no friends. Our relationship grew even more confrontational as I tried to regain my authority and he rebelled. I didn’t blame him. I was a sibling, not a parent. But someone had to do something.

As the foreclosure papers rolled in and the utilities were cut off one by one, I knew it was up to me. The house was gone. I knew that. It was beyond saving and my mother would not allow me to call the police to get dad out anyway. I started to sleep in her room every night with her metal cane by my side. When he would come in looking for money or high as a kite and angry, I would stand in the doorway, the cane in my hand. I was the only one he respected or feared because, as I told him multiple times, I was not my mother and if he did not leave us alone I would call the police in a heartbeat.

I knew that I could keep him at bay only so long, so I took my mother, my brother and a tent and we began sleeping in camping parks and looking for a house. We found a home I could afford on my credit alone since I had no job at the time. With my mother’s disability, it was all we could do to pay the rent and the utilities. With the help of friends we packed up the house, leaving a great deal behind. Almost everything of value was already gone, pawned off, so there were really just a few things like books and dishes to be packed.

We left the house and moved miles away, not even giving a forwarding address beyond a post office box for fear my father would follow us. We found out that he had been arrested only two weeks after the move.

It has been many years since all this has happened, but it is still fresh in my mind. I am still functioning as the father and the husband in my household. I have made an effort to change my role but it is hard when so many are counting on you. Even in my extended family I am the only one responsible enough to hold down a job and raise a family.

As I have gotten older, I have been looking to create a family of my own where I can take on a more fitting role. However, that means that I have had to have many discussions with my mother, grandmother and brother about taking responsibility for their own lives. I do not want to abandon them like their other fathers and husbands, but I have to face the fact that if I ever want a family of my own I need to let them go.

I know my story is a long one and I tried not to go into too much detail. However, readers should understand that when fathers do not take on their responsibilities someone has to. It might be the mother, it might be the police, or it might be a child. That is why it is so important that fathers are aware of what they are getting into when they decide to start a family. It is not all fun and games and freedom. It is hard work, but it can also be very rewarding. Take it from me: a father, a husband, a daughter and a sister.

Author Byline:
Blogging for was a natural progression for Allison once she graduated from college, as it allowed her to combine her two passions: writing and children. She has enjoyed furthering her writing career with She can be in touch through e-mail at 

Tuesday, May 21, 2013

More Recent Psychiatry News Headlines of Relevance to This Blog

When psychiatry news breaks, I fix it

Maybe it's because they aren't residual symptoms 

4/5/13.  Small Study: CBT May Improve Dysfunctional Attitudes In Euthymic Patients With BD.

Medwire (4/5, Cowen) reports, "Cognitive behavioral therapy (CBT) improves dysfunctional attitudes and is associated with a reduction in residual symptoms in euthymic patients with bipolar disorder [BD]," according to a study to be published in the September issue of the Journal of Behavior Therapy and Experimental Psychiatry. "The findings come from a study of 57 patients with remitted bipolar disorder.

It is amazing how many psychiatrists assume that when a patient with true manic-depressive illness is not in either the bipolar depressed or manic state, any emotional problems they may exhibit must be due to the underlying disorder. In fact, when patients with bipolar are euthymic (in the normal state), they can have any mood or any behavioral problem that anyone without bipolar disorder can have. 

They can be unhappy, have interpersonal problems, or have personality issues that have absolutely nothing to do with bipolar disorder. So of course psychotherapy can help then. On the other hand, try doing psychotherapy with someone in a full blown manic state, or in a severe depression with marked mental slowing (psychomotor retardation). I dare you.


It’s About Time, Department. 

5/1/13.  Colleges Tightening Rules On AD/HD Diagnoses, Prescriptions.
The New York Times (5/1, A10, Schwarz, Subscription Publication) reports that "dozens of colleges [are] tightening the rules on the diagnosis of" attention-deficit/hyperactivity disorder (AD/HD) "and the subsequent prescription of amphetamine-based medications" to treat it. "Some schools are reconsidering how their student health offices handle AD/HD, and even if they should at all. Various studies have estimated that as many as 35 percent of college students illicitly take these stimulants to provide jolts of focus and drive during finals and other periods of heavy stress."
Lawsuit Filed Against Harvard Spotlights Issues Involving AD/HD Diagnosis. In a related story, the New York Times (5/1, A12, Schwarz, Subscription Publication) reports that a lawsuit filed against Harvard University "provides rare detail on the issues involving a diagnosis of attention-deficit/hyperactivity disorder [AD/HD] from a student-health department." The case centers around a rising sophomore who had been prescribed a medication for AD/HD "after a single examination at Harvard University Health Services." The young man went on to commit suicide about half a year later after he received a prescription for antidepressants. The father of the victim "contends, among other accusations, that his son had never had AD/HD and that Harvard's original diagnostic procedure, and subsequent prescriptions for Adderall [amphetamine mixed salts], did not meet medical standards."


What hath Whitaker wrought? 

5/1/13. Concerns Mount Over Anti-Psychotic Drug Spending In California Prisons.


The AP (5/1) reports, "Under federal court oversight, California's prison mental health system has been spending far more on anti-psychotic drugs than other states with large prison systems, raising questions about whether patients are receiving proper treatment." According to the AP, anti-psychotics "account for nearly $1 of every $5 spent on pharmaceuticals purchased for the state prison system." Sharon Aungst, formerly the chief deputy secretary for the Division of Health Care Services, "said there was a tendency for prison health care workers to practice 'defensive medicine' for fear of triggering a lawsuit or violating federal court orders."

The anti-psychiatry crowd wants people with chronic and persistent psychotic disorders to stay off medication, and to stay out of psychiatric hospitals unless they want to be there. So instead, these patients end up in jail, where they get the medication anyway! I guess that means they are better off.

At least the private prison industry is happy. They have a lot more inmates than they would if these folks were in hospitals, so they can make a lot more money. Using your tax dollars to do it!  (Hospital care is actually a lot cheaper than prisons).

Assessing violence potential?  How about just asking the patient?

5/7/13.  According to a new article in Psychiatric Services, clinicians are often called upon to assess patients’ violence risk, and many researchers are focused on developing accurate tools for this purpose. Why not ask the patients themselves? The lead article describes a study in which clinicians did just that. They interviewed inpatients who were considered to pose a high risk of violence, using two well-regarded tools to rate the patients’ violence potential. They also asked the patients to rate their own risk. Patients’ ratings were fairly accurate in predicting violent behavior two months after hospital discharge—more accurate than predictions based on the two clinical tools.

Gee.  Finding out about patients by just talking to them gives doctors more accurate info than having them fill out an "empirical" checklist?? Who'd'a thunk?  I wonder when psychiatrists who are so enamored by “objective tools” will realize that they give far less information than an intense clinical interview. This is particularly true when the doctor can spot inconsistencies and plot holes in patient’s stories about themselves, and ask incisive follow up questions.  

Computers are terrible about doing that. And the superiority of clinical interviewing goes double for so called “empirical” research studies, so the holy grail of “randomized controlled studies” ain’t so holy for psychiatric patients, who are a hell of a lot more complex and multi-determined than any other possible object of scientific study. Most of these studies rely on "tools," (and are often performed by them). 

Tuesday, May 14, 2013

Genes, Environment, and Strategic Planning in Human Behavior: a Primer

Most psychiatrists used to agree that, in order to best treat patients with psychological problems, we should use what has been termed the biopsychosocial model. This means that both the behavior problem and/or mental disorder is caused or maintained by a combination of factors including biological and genetic propensities, psychological processes including affects, cognitions, defenses, etc., and social factors such as dysfunctional interpersonal relationships and history of trauma.  Treatment should address all of the important contributing factors.

If fact, there are no biological, psychological, or social factors that are either necessary or sufficient to produce the vast majority of mental disorders and behavioral problems. There are only risk factors, or factors that increase or decrease the odds that someone will develop and/or maintain such problems.  Whichever factor you choose, some people will have none of it and will develop the disorder, while others will have a lot of it and not develop the disorder.

In theory, no one in the field will admit that they favor only focusing on one domain or another, or as philosophers call doing that, reductionism. But lately, psychiatrists in particular are using a bio-bio-bio model. In particular, genetic influences on behavior are grossly exaggerated, despite the fact that any neurobiologist worth his salt knows that no complex human behavior is caused by one gene or one group of genes.

Human beings are not very instinctual. A great deal of what we do is learned.  Hell, we don’t even know how to do something as biologically important as procreate, unless someone tells us how or we discover sexual intercourse through trial and error. (Fortunately, most of us figure it out eventually). We all have the biological urge to merge, of course, but how to go about it? We don’t know innately. Unlike say, a certain species of wasp that always does a complicated mating dance that is identical to that performed by every other wasp of the same species - without the benefit of having seen another wasp do the dance.

It is important to remember that the vast majority of genes in a given cell are turned off. They ain’t doin’ nothin’. They only get turned on by environmental factors. In terms of neurons, the environmental factors that turn them off and on are quite often those from the interpersonal environment. Furthermore, all neural pathways in the brain compete with each other in a Darwinian, survival of the fittest sense. If they are not stimulated by the environment, synaptic connections between neurons weaken and then disappear altogether. If they are stimulated repeatedly, they get stronger (long-term potentiation).

The only exceptions are certain tracts in a part of the brain called the amygdala, which form early in life in response to attachment figures. You know, parents. These synaptic pathways seem to be highly resistant to weakening through the usual process of neural plasticity. They can be overridden but not destroyed. There are, in fact, cells in the amygdala that respond only to a mother’s face, and others that respond only to a father's. Maybe Freud was on to something after all.

And then there’s the matter of a major function of the human brain: the ability to set goals, make mental models of possible strategies for achieving those goals, planning them out, anticipating and visualizing problems that may arise, putting effort into them, revising them along the way as new information becomes available, and then achieving them. This brain function seems to be thought of as non-existent by those who study the "heritability" of human behavior. This, despite the fact that those who design such studies are in the process of doing that very thing!!

Allow me to provide a primer on the nature of human behavior and its antecedents, using human language as the example.

Beginning with linguistics expert Noam Chomsky (whatever you think of his politics being irrelevant), linguists have shown repeatedly that there is a huge genetic component to human language. The human brain structure limits the possible syntactical and grammatical forms language can take, as well as the available sounds.

Noam Chomsky

However, whether you speak Greek or Swahili is entirely determined, 100%, by your environment.

And whether you speak Greek and Swahili is usually determined 100% by your conscious decision to learn a second language and the effort you choose to put into the task.

Tuesday, May 7, 2013

Strategies for Initiating Discussions of Family Dysfunction

In several previous posts (The series Ve have Vays of Making You Talk, and How to Disarm a Borderline), I have discussed ways in which individuals who experience ongoing and repetitive family discord can overcome the defenses and sensitivities of other targeted family members in order to change these patterns.

I have neglected one important consideration, however.  How on earth can a person get such a conversation started? For discussions of these patterns (metacommunication) to be successful, it is vitally important to get off on the right foot.  Otherwise, metacommunication can quickly provoke fight, fight, or freeze reactions in everyone concerned.  

Metacommunication will end as quickly as it started, and family behavior may actually deteriorate even further.  One’s initial approach to the targeted other is usually critical in determining one’s ultimate success or failure at any given attempt at metacommunication.

A successful start may allow ideas about the family dynamics to be discussed without encountering undue defensiveness or invalidation from the target. In turn, the discussion of family dynamics allows an individual to empathically discuss the nature and origins of difficulties in his or her own relationship with the target, and potential ways to improve it.

Unfortunately, a strategy that works wonderfully in one family may lead to disaster in another family that may superficially appear quite similar. Every family has its own unique set of variables to which they over-react! There is usually no way to know in advance what the best opening will be. Figuring out the best approach usually requires the assistance of a therapist. Nonetheless, in Part I and Part II of this post, I will discuss five possible initiating approaches.

In doing psychotherapy with patients, when I start to help them shape an initial approach, I usually try one or another of the five potential strategies in a role playing exercise to see what my patient is up against. I generally stick with a given strategy even if the target’s initial response is a negative one - such as evasive maneuver or a verbal invalidation of the patient. Such maneuvers can often be countered with specific responses that are employed as the conversation progresses. 

However, if I seem to get in trouble with escalating negativity from the patient playing the targeted other even while employing the usual countermeasures, I know that I should stop, and try a different initial approach. 

Of course, all the usual approaches may not work, so ingenuity is required. Every time I am foolish enough to think that I have heard every possible negative response, I am surprised.  But where there is a will, there is definitely a way.        

What follows are the first two of the five suggested initial strategies:

1.  The first option is to begin with a discussion of family history, using the core relationship problems as they were manifested in past generations as a metaphor for current interactional difficulties. To use this option, a potential metacommunicator should have already done a bit of research about the history of the family emotional process and the family history by constructing a genogram.  

I will not go into the complex subject of genograms here; an example of the kind of information needed can be found here.  Of crucial importance is the relationships parental figures had with their own parents, as they were affected by such historical events as ethnic and cultural values, changing circumstances, illnesses and premature deaths, immigration, mental illnesses, child abuse, and emotional cut-offs.

The metacommunicator starts with non-threatening questions about family history and then goes on to discuss more emotionally charged past family interactions that parallel the current problem. Next, the metacommicator slowly traces with the target the history of the family problem all the way into the present day, as it has come to affect the individual's current relationship with the target. 

This strategy was the first one I devised and is discussed in more detail in my first book (Allen, 1988). Current problematic roles being played out by family members stem from issues that develop over at least three generations. Therefore, any problem in the present or in one’s childhood has precedents in the interactions of the members of earlier generations. 

For families that do not produce individuals with borderline personality disorder (BPD), strategy number one is often the least threatening option. It tends to be much less threatening for parents to discuss long past relationship problems with their own parents, with their siblings (the metacommunicator’s aunts and uncles), or even with the other parent than it is to discuss those very same problems as they exist with the metacommunicator in the here and now. 

The negative impact of the issues seems muted when viewed from the distant perspective of the past. However, once the analogous issues have been brought up for discussion, one can gradually demonstrate how the earlier difficulties have led to problems and miscommunication in the present. The metacommunicator can then say something like, “No wonder you reacted so strongly when I did [such and such]! I wish I had known that before.  I always thought you reacted because [whatever explanation one had thought to be true previously].” 

During this process, one receives confirmation or clarification about the family dynamics. In this scenario, the parents should feel that their adult child is really trying to understand them and not attack them.

Unfortunately, I have found that in families that produce offspring with BPD, strategy number one is often the worst option. In these families, the parents usually do not want to touch their feelings about their own families of origin with a ten foot pole. There is so much repressed rage and anguish from the past that it is in fact easier for an adult child and his or her parents to talk about the here and now first. Rather than seeming distant, the past seems more alive in the present than it ever has.  

Even getting the target to describe interactions in previous generations for purposes of gathering genogram data can be extremely difficult. The parents do not want to even think about their relationships in the past for fear of triggering an all-consuming emotional reaction. This leads us to strategy number two.

2.  The second option is the most direct of all. Metacommunicators cut to the chase and move directly into a tactful confrontation about how the target's current behavior affects them adversely.  The term “confrontation” as I am using it here means bringing up a problem for discussion, not picking a fight.  

If a direct confrontation is to succeed, there can be no sense whatever that the conversation is an adversarial proceeding. Adult children must remain absolutely empathic and say nothing that clearly suggests that their parents are to blame for their own problems, even if they had been severely abused. The best way to start such a confrontation is to employ disclaimers. The use of disclaimers was discussed in a previous post.

The opening gambit in this strategy is a statement such as “Dad, I know you always wanted me to succeed in my career, but when you did not come to my graduation, I began to wonder if somehow you might be threatened by my success.” The metacommunicator then say nothing further and awaits some kind of response by the parent.  Depending on how the target responds, the metacommunicator and the target should then go on to discuss how they have been misreading one another’s intentions because of behavior they have both manifested that was due to each person’s own internal conflicts. 

The metacommunicator must be careful to acknowledge his or her own contribution to any misunderstanding while explaining that his or her behavior was due to a misreading of the target’s motives. Such a conversation can lead to discussions of the past family history that has lead to the conflicts. If the target has a high level of emotionality about past interactions as mentioned previously, however, that part of the conversation must be approached with exceptional delicacy and tact.

In the next post of this series, I will describe three more possible strategies for initiating family metacommunication.