"Abandoning your sense of reasoning, that's like you or you or you, sometimes. Right, Grandpa? I'm like you."
We begin with good intentions; inclusive; not offending anyone; and staying away from deep issues. (Destroy by a comment or family silencing members viewpoints.) These persons begin at the grade level of "E"
I formed a psyche emotional grading system that I taught in reverse at Mayo Clinic Psychiatry Center for Children. (I"ll keep the explanation in the standard order ABCDE.
Emotions are your smoke alarms. The alarms are real. The choices 'can' be confusing. We want to hit at the alarm to stop it. It takes courage to think of intelligent choices without hitting back. Courage to move form the grade "E" to "A". Mayo can help!
Accent the positives, Accept negotiation
Behavior of your brain and body
Communicate, Care, Consideration (Cool, Can)
Emotion, the Experience of perceptions
My students, especially one sixth grader, worked on the ABCDE with anticipation for each letter grade. The ABCDE lessons were required penmanship assignments copying one letter a day beginning with E. He was on letter "B", behavior of body and brain. He had truly completed moving from "E", his emotions controlling his actions through D, determination, and "C', communication. He acted like a young man with "hang-ups", and anxieties: weight, girls, and parents but he was aware he had choices and was not alone. When called names concerning his weight he rehearsed, "Please call me by my given name. My name is Bret, thank you," as he turned or moved away. ("B for Bret's Bravery" was my entry in his daily journal.)
If your behavior isn't taking you anywhere, why go there?
Sense the reasonable solution.
Low expectations, children will meet them if defined by friends and classes of people in their surroundings. Our survival compass balances to the new norm of the environment. Jeff's example exudes my point. He was a heavy set, intelligent, and affable - away from his family. His family took comfort in knowing that he probably inherited his mental condition since there were two cousins with schizophrenia, two aunts with depression, a grandfather and several cousins abused alcohol. My heart ached from the lack of empathy available to this child.
Jeff saw no justice. He pounded his head against walls, smeared feces and urinated indiscriminately. He clearly knew better. He was irritable much of the time. His sister feared being alone with him and he was jealous of his younger brother who had encephalopathy. Jeff felt particularly responsible for his brother's diminished capabilities. He knew his sordid history and wanted out - out of society and out of his family. Expectations, none. He attempted suicide by wrapping his baby blanket around his neck to suffocate. He wanted to die and said so regularly...family expectation?
I used optical illusion sessions to capture the students' understanding of the importance of seeing and asking their brains and others what they were seeing. Here are two specific optical examples that were well received. The first, with my back turned to them, I would sneakily and dramatically inform them that I was drawing line segments on the white board. I would stereotype a mad professor and tell the class I was putting arrows, carets, ray symbols, greater than or less than symbols to the lines. I would pivot back from the white board with my "Vanna White" impersonation and ask them to describe what they saw. All observations were accepted. The arguments ensued and fed discussions for understanding frustration and confusion concerning personal feelings. The feelings that disturbed their minds, that the lines were all equal lengths.
The second illusion perspective that lead the students into trying other solutions, The space ship. I would say, "Make your hands into fists. Point your thumbs toward each other moving them closer and closer to each other until they almost touch. Keeping your eyes focused on your thumbs, slowly move them toward your nose while staring at the tiny, tiny space left between your thumbs. Tell me when your space ship lands." Eeks and giggles would follow. Line, color, shape and focal point fooled the mind into believing what is not there. But their anticipation lead them to broaden their views of themselves, parents, siblings, and classmates.
Listen to differences to the discovery of what we/they have in common, attainable hope for children. Let's help children find their own equilibrium, setting specific, attainable expectations. Thus, setting sail on their own course in society.
Let Halloween begin, flash back from within, in the land of "Mayo" (Mayo Clinic psychiatry), where, ages ago truths were told of Halloween of old. Halloween week was a screech, truly and paradoxically. I felt properly gleefully gloomy and grim. Since no child in the class had a "bug" phobia, I had planned with gruesome bliss.
"For I am cantankerous already,
But I say that with a grin
Since my little spirited sprites
Discover unexpected surprises
From their person within."
My computer savvy kids nervously had maneuvered their way through the gauzy web and had settled on the carpet near my webbed chair. The Witch Has an Itch by Donna Guthrie and illustrated by Katy Keck Arnsteen (Aladdin, 1990) waited for us. The story unfolded the dilemma of Gormelda, a wicked witch and proud of it. She was the meanest magic maker in all the land with a major psychosomatic glitch - evil made her itch. To keep her reputation, she scratched and itched incessantly until it was unbearable. She sought help from the powerful wizard, Womack. He explained that there were different kinds of reputations. She could be the nicest witch in all the land. Her choice. Where does one start? Womack advised that she could start from scratch - with a smile.
The class discussed Halloween stories and cultures from around the world. They computer researched what interested them, such as: The Celt's huge bonfires to scare away demons and wearing ugly apparel to fool the demons into thinking they were one of them and would do them no harm; Roman festival to honor Pomona, goddess of Gardens and Orchards; how Halloween got it's name, the short way of saying All Hallow's Eve, the night before All Saint's Day ((which happens to be the day I was born). I tried to act saintly, but my students quickly pointed out that was a long stretch. Or, as Jas quickly stated, "You're pushing it, Dr. K."
Sensitively, we discussed Halloween relating to religion, spirits, death, and superstitions. The children took the opportunity to tell of concerns of death and things that particularly frightened them. They poured forth suggestions for handling fear and nightmares appropriate for modern times: Leave lights on; changing the channel in your mind like television; shutting down their minds or delete like a computer; telling someone; writing down their fears. For the older kids it reversed the negative caveat of their own fears by sharing their wisdom. The younger students' anxieties seem relieved.
Emily Dickson, I'm not but the empowering poems and stories collected from their research reflected truly heartfelt fears and solutions from within.
The grins of Halloween conquering fear. The yearly positive caveat on Halloween Day;)
The little kids that wouldn't; pugnacious at 8 and 6-years old.
Brother and sister, Frank and Ellen, fetal syndrome patients to the Mayo Clinic psychiatric unit, joyously bounded into my classroom. Both siblings were ADD, attention deficit disorder. Frank was eight who looks small for his age and, literally, came into this world foot first; thus with a congenital left hip dislocation. He had a small face, lopped ears, and a grooved eyelid of the two moveable folds that protect the anterior surface of the eyeball. He had a history of aggressive oppositional defiant behavior (ODD) that was somewhat controlled by medications. Oh, he hated his mother.
Frank had run away in the rain with 6-year old Ellen. Their step-dad found them at a gas station. Earlier on the way home from seeing his psychiatrist, Frank left the van and ran, climbing to the top of a scaffold in a construction site. On the day of his hospital admission, his mother had been called to school, where she had found two men holding Frank down. He was spitting, hitting, kicking and biting school personnel. This was his first serious incident in school. Frank bullied his sister, chased siblings with a stick, threw rocks at his mother, tied up the cat's legs, hit the dog and loved to hear it yelp. He argued with adults incessantly; pugnacious.
Ellen entered with bilateral drooping eyelids, a small face, loped ears and dysmorphic facial features like Frank. They both usually came dressed in dirty clothes and unkempt hair. If they arrived before the nurses removed surface blotches and smudges. Ellen spoke softly with diverted myopic eyes. At age one she had had corrective surgery for ptosis (drooping of the upper eyelid from paralysis of the third nerve). Since age three her parents reported increased intensity of her outbursts toward her family several times a day, with temper tantrums lasting up to 15 minutes each.
Medication of Tenex had been discontinued due to night terrors; Prozac discontinued due to aggression (she killed her kitten) and Ritalin and Dexedrine discontinued as they had had no effect. Ellen's mother was not sure of the dose or time usage of these medications.
Ellen had been born with the umbilical cord around her neck while her mother had had a joint in her mouth and a drink in her hand, pollution of minds and spirits. This was her second child and a third on the way. (My passive-aggressive symptoms surfaced there for a moment.) More accurately, the mother smoked marijuana once or twice a week during the first 45 days of pregnancy and at four months of the pregnancy became inebriated on her wedding night.
Ellen had been admitted under the hospital code: Resuscitate.
Her mother had suffocated the biological life out of the child. Ellen was a child who needed a new orientation for reasoning and awareness that for her was caring sharing "village" somewhere. Frank had taken advantage of her moderate mental disability to badger her, but she had a teasing streak that was her redeeming charm. Ellen's "mistake" was that she used it on the wrong person, her step-brother. She became his target. In self-defense she created an imaginary friend, Gumpy.
When she began her schoolwork, I would remind her that Gumpy was at home sleeping, but she may have one of the stuffed animals or baby dolls from the shelf sit beside her. I'd tell her, "I like you, Ellen, and I would appreciate time to sit and play with you if you're not too busy after your work is completed." The scramble would be on for the comfy toy and work.
Frank's biggest transgression was being ugly, or for the intellectual, sensitive, unattractive. He had realized neither condition was acceptable in his society. His own compensation strategy might have read, "If you cannot be beautiful, be bad. Pugnacious. I chose that time to give him the gift of my own ugly duck story. It went something like this.
As a young girl, I loved the water and wanted to swim, no matter what. I, also, had very poor eyesight. Fearing for my safety, the swim instructor tied a strap to my glasses for swimming. The other children laughed at me and called me names: four eyes, frog eyes, or and ugly duck. At first I got angry, then one day I looked in a mirror. I did look like a frog. But I didn't mind the teasing because my goal was - and here I gestured to Frank for the answer." He blurted, "To swim." "Yes, Frank, you are thinking. My goal was to swim fast, so I laughed with the name callers, or I shrugged and said, 'Yup, I do look strange." I learned to let the teasing words simply run off my back as water runs off the back of a duck. Ducks swim in lots of "yucky" water, but they keep enjoying their swim. When you feel angry close your eyes and remember your goals and let yucky words run off your back. With a demonstrable back hand swoosh, over my shoulder, to swipe those words 'off'!
The kids that wouldn't have the same opportunities of their peers would use their pugnacities of courage for their goals to conquer their world. I would use their feisty energy to fight for health care - inclusive of mental health counseling.
"Teach the children so it won't be necessary to teach the adults." Abraham Lincoln
Curt, my 12-year-old student, was an exemplary example at a young age. He was a compulsive disruptive behavioral student and encopresis (wetting from fright). Curt alleviated a love-hate triangle between Olivia, Eric, and Melanie. He handled the situation with presidential aplomb.
Olivia and Eric had come to Mayo's child psyche unit frustrated, discouraged, skeptical, and fearful of help; simply fed-up with society. Olivia had become caught up in emotionally charged situations and appeared to perceive and think in a unique, though inconsistent, manner making her weak in judging situations causing numerous errors.
One morning, Eric, the object of Melanie and Olivia's desires, had accidentally pushed a note on the floor. Olivia picked up the note and screamed at Eric. He had not read the note as indicated by his look of disbelief. His curiosity overrode his response to Olivia's accusations. He grabbed it from her and read it aloud, "Do you love me, check yes or no." Peels of laughter. Oh, what had George Strait's country song caused? Melanie enter the fray, "Eric, I wrote it. Didn't you see me put it on your desk?"
The entire episode took only seconds. I hurried across the room and asked Eric to put the note away. Here I implemented with, "Rewind, back to good behavior, please." They all backed to their places. (Walking backward intervention helped anger dissipate the confrontation and gave me time to think.) But the solution came from having taught the child, Curt.
Warmhearted 12-year-old Curt parroted my schoolism comment, "School is for working on relationships. If you find friendship that's a bonus. Eric and Olivia, you should talk about it during break and next time find out facts before judging. " He looked up at me and explained that his father had said, "Remember when you point your finger there are three fingers pointing back at you. We have all done things we are not proud of." I responded, "Well said, young man."
I felt a twinge of separation anxiety for my OCD patient was ready to exit...President Lincoln would have been proud. A well learned student. His adult problems would be easier to handle.
r "The best laid plans of mice and men (slash that last word-change to teacher) often go awry." Robert Burns. Eight year old Carl had a plan for my well organized day on the children's psych unit, unbeknownst to the teacher, of course.
The story went like this. Carl was an Asperger's patient who had a fixation for fans particularly pink ones. The staff informed me of his situation: Psychotic Disorder, disorganized incoherent speech, attention deficit hyperactivity disorder (ADHD), and behavioral disorders-plural.
"Please," his primary nurse requested, "do not mention, teach, or refer to fans in any form for the next couple of days while the nursing staff sought an area of functioning." My educational assistant and I scanned the entire room to completely comply. We removed all pink items, including crayons and flowers.
Carl came to my room at the worst possible time. The group was seated at a side table to play Brain Quest (Workman Publishing, 1992), a question and answer educational lesson using cards similar to trivia cards, but anchored in the lower corner. It's similar to a television quiz show, going around the table giving each student a chance to question several times. I used this as a social interaction technique.
The six students (who knew nothing of Carl's history) politely waited for Carl to be seated and promptly unfolded their cards into a fan shape. A fan-fare of gasps and choked sounds emitted from my lips. Never before had I seen ALL the children fan the rectangular clumsy cardboard packet of twenty or thirty cards simultaneously. Maybe, one or two cards as one browsed in search of a difficult question, but never the complete packet.
The timing of the event robbed me of my voice. I speechlessly looked on as Carl, joyously blurted out that he "just loved fans". He happily asked how he could get into the game, gave us a rendition of the history of the fan and that his favorite color of fans was pink. We were given all this information in segments as he gladly sat down stating on how he was going to like it here. The staff and I laughed all day about the best-laid plans of Dr. K. But, I can't stop there.
One more concluding unperceived Carl incident. Carl was overly anxious, obese, and had food and animal allergies. He had periods of unintelligible speech. I was helping with his communication breakdowns by telling him that speech is like writing a sentence. We pause at commas and stop at periods. Breath. Look at the listener. Continue. Carl immediately announced, "I live with my mom, (pause) a chinchilla, (pause), and bearded snakes (complete stop)." Yup. He stopped everything. I thought to myself, "I'm loving this kid!" My best laid plan, ever! Love.
"No way would my dad, mother, grandmother, grandfather, or anyone help me."
Really, really, yeah, this is what nine-year-old mute Harold, who arrived in my Mayo Clinic classroom eventually conceded, He had consciously chosen mutism when asked for responses.
The first day, it was the clamped closed mouth expression. I made no mention of it, but instituted writing notes, sticking post-its on his papers, or including him, generally, in group activities. He behaved and complied unexpectedly well. Our written notes strategy was successful; but, on completion of assignments he soon saw "ask me" for his favorite choice of reinforcement. I postured total unawareness when he approached. We seldom made eye contact. If he let out an inaudible squeak I would say, "Yes, your work is complete. I insist you take a break." With a snickering sneer he would bound to his choice of leisure. (Methought, "Harold, you had talked without hearers and shut out society")
Harold progressed. He asked his nursing staff if he could play with the objects in my "museum" office - off limits to him. I heeded his request with a contingency. He must play quietly;). He was required to say at least three sentences about each object before exchanging it for the next. His comments alluded to an angry father and mother not supporting him when he felt that he needed them.
However, one verbal exchange became lengthy on how to make a Jacob's ladder toy. This needed square pieces of wood and ribbon to inter-lay between wood in and over-under pattern allowing the pieces to fold and close in a ladder-like sequence. He agreed, in time, that he had gifts of observation and artistic ability. He could draw pictures and had even used an old deck of playing cards to copy my Jacob's Ladder. Not the same quality as the Appalachian people who had made mine (passed down from my mother-in-law), but he had the same ingenuity. I reminded him that he could climb the ladder to living 'okay' when he felt unsupported. Keep Jacob" in his pocket along with the doodle pad for drawing whatever he felt.
Harold's parents realized the in-person interactions, post-it notes, stickers, silently or orally would help make living 'okay'. They could all climb the ladder together. Listen.
Really, really, yeah!
A cautionary tale of skill knowledge. "The amount of opioids prescribed in 2015 was still more than triple the level in 1999, and varied widely by the Centers for Disease Control and Prevention." The problems concerning overdoses and addiction, by the many, is explained with "It's all in their heads. They are head cases. That's how they get hooked." Physicians, insurance companies, and business companies are seeing the psychiatric connections for genetic and biological origins. All of which are, now, gradually, being seen as intertwined for routine care medical care. Wee have just begun.
I remember feeling like a "drip" in patient conferences. Especially, the indifference to the mental health issues for my HIV student and my cancer patient. The physical issues over-shadowed the mental ones. A number of times I would walk out feeling "drippy". I would throw cold water on my face before returning to my classroom. Reminding myself of my lesson for my children, when they used the expression, "I feel like a drip!" for their sappy emotional feelings.
The Drip effect, in particular, brings Kerrie to mind. She was the first. I recall, grasping the teaching moment. I had rushed to our sink and had turned the faucet to drip. I silently watched the drops. The room began to quiet in vary degrees, but I out-waited the most resistant. As we all listened to the drip, I would explain that at times each one of us feel unpleasantly drippy.
Then I held a glass to catch drips and I said,"But the great thing about drippy ideas or the drips that you think that you are is; that you can build up and flood the world with new ideas. Continuing metaphorically, Ideas seem drippy because they are new and make us uncomfortable with changes in ourselves and others. The next time you feel like a drip, take a few gulps of water and flood yourself with a new positive thought; or get together with a few other drips and flood the world with new, young ideas. Simply trying will flood you with warmth."
These are the young children, who, often use drugs to alleviate pain. The drug opioid overdosed problem of today began with separation of fields of care. Their physicians deal with the physical needs while overlooking the underlying issues. Multiple medications or increased dosages are, sometimes, prescribed leading to over medicating and overdoses.
I'll take a long drink of water and, with my skill knowledge, push a "drippy?" idea; non-isolation of mental health care and medical care.
Here comes a drippy idea. Let's create a flood!
The proverb, "Children should be seen and not heard."
This is "Extreme parental style #1". According to Don"s dad, this is the only way to raise a child. Children do not make decisions.
Don, age 12, was mentally and physically wretched. He entered in handcuffs. He lived on and off the streets. He and his father lived with a woman who was employed, but she disliked Don. He enrolled dirty with multiple insect bites covering his body with lesions around his anus. He appeared somnolent-sleepy. His father dispensed medications inconsistently from a tin box in accordance to Don's behavior and withheld bowel medication to discipline him. His appearance was worse than a Charles Dickens' street urchins. When time permitted, the nursing staff washed him before school and gave him clean clothes, but the following day Don would appear in his old clothes for school.
Staff reported that the father had Don on Trazadone, but the father denied this. During free choice time Don would sit in a corner re-enacting sexual behavior of adults adults he had witnessed. It was overwhelming. Don uses drugs.
Extreme parental style #2. We make all decisions together. I am your best friend. (Mother/daughters were the most common on the ward.) These children were the most disconcerting to help. Their situation confusing and toooooo perplexing for ages five to twelve years old. The parent or caregiver had "empowered" the child in family decisions. The sweetness buried the child's own identity. In public the child looked perfectly accepting of the situation. Too late to escape the emotional smothering that had covertly encompassed the child.
To today's parents:
1. Allow children to make some decisions. Be wary of toooo much clout. (You are the boss. You are wiser. You are not their best friend)
2. Parenting comes first. Best friends categories, often, means the parent or caregiver, or the child is filling a personal void. The child doesn't develop their own incentives, if parents organize the child's life around themselves. (Entitlements often creep in)
3. Set limits by having fewer options, especially, younger children.
Extreme parental styles lead to drug use and suicide, according to my Mayo Clinic teaching experience. Parents and or caregivers make the 'family' involved decisions with these last words heard,
"This is a family."