Monday, June 11, 2012

Something Good

She was referred by one of my crazier patients so at first I was a bit skeptical.  Well, she wasn't exactly referred, she was brought.  There they were in the waiting room, so what could I do.  I gave her an appointment for the next week.

She is seventy years old, and she looked it, with her slightly unkempt gray hair and leaning on a walker.  She could have been eighty.  A few days before I was to meet with her I had a session with the patient who brought her.  She told me that she was clear that I would never mention either one of them to the other, of which I certainly assured her, but then she told me that she would be coming again with the new woman because the new woman admitted to my patient that she didn't know how to read or write.  My patient did not know if the woman would tell me that, at least not right away.

Given that, I didn't know what to expect, because in our brief meeting she seemed articulate enough.

The session began with this new person and the woman told me she had never been in therapy before but she thought she could use some advice.  Then she told me that she never learned to read. She said she had been traumatized by nuns.  Her parents came from overseas and no one spoke English at home.  When she got to school in first grade the nun was embarrassed that she had a student who not only couldn't read, she could hardly speak English. So the nun placed her in the basement of the church and made her copy the alphabet every day.  She got no further instruction, but has beautiful cursive handwriting.  When she tried to tell her parents what was happening they could not believe that the good Catholic Church would treat anyone that way, and if they did, they much have their reasons.  So nothing was done.

In second grade she sat quietly in the back of the class. She thinks that  he teachers must have thought she was retarded, but no one ever did or said anything. That remained true until high school.  She went to a vocational high school and took up cooking.

At seventeen she met a man four years her senior.  He decided that they should have sex. when her parents realized they were doing that they decided they should get married.  She married him and had four children before she was twenty-two.  She realized that he only used her for sex, and was also having sex with others, so she one day she locked the door and told him if he opened it she would break his head open with a hammer.

He moved to Florida.  Only one of her children ever had real contact with their father., and he took that son for a few thousand dollars.

From then on she took control of her life. She opened a catering business that she ran, very successfully for forty years. She had a staff member write the menus, and she didn't need recipes. She raised her children by herself and they are all on their own and doing pretty well.  The two who still live close by keep in touch with her often.

She retired five years ago and moved in with one of her daughters. Last year, as her grandchildren were entering adolescence she decided that she did not need to be around the noise and chaos, so she moved into what she thought was elderly housing.  The problem is that "elderly housing" in the city where I work is also filled with many interesting and colorful souls, and her hope of hanging out with some nice older women who would talk about their children, cooking and sewing met the harsh reality.

However, before she came to the appointment she had already begun to make some contacts away from the apartment complex, to find some people she may want to spend time with, and to learn how to be polite but distant with those around her. I was able to help her sort out who to see and where to go that could be more enjoyable.   She seemed to be very insightful, and we decided to meet a few more times to make sure things work out. I don't expect that anything more pathological will emerge; she was a very unexpected surprise.

She also told me that now that she is alone in her own place, with no one to push her or evaluate her, she is teaching herself to read.  She expects to have the hang of it by the Fall.  She wants to read that Fifty Shades of Whatever, that her daughters are talking about.

Tuesday, June 05, 2012

More American Worries

Went back to work again this week and the more I sit and listen the more I have to worry about.  My patients are the least of my worries.  They come for help.  Most of them have a good idea of what is wrong and they are trying to get their lives together, many from very chaotic situations, crazy families, and a tough economy.

But it is what my patients tell me about what is happening with their families, extended families and communities that worries me more.  There is such a growing number of people who are slipping away.  There are more and more people who can't function well in this world as it becomes faster and more complex.

Much of it is the result of all the new technology, the globalization, the recession, and the deterioration of families and the educational structure.

There are three kinds of populations that are really not doing well and they have very little hope of improvement.  They will become increasingly expensive to society and no one seems to have a real workable approach to solving these problems.

The first group has always been there but now there are more of them; the poor, minorities, unskilled, learning disabled, and left out.  These people are now unemployed all over the world.  More and more places are looking like India with some very rich people, and many more very poor.

Now there is a second group that had been a rung above the forever under-class.  Now there are more mainstream people who had been working but are no longer needed.  The older ones, who worked for twenty to forty years in jobs that have been made obsolete by technology, or out sourced, are just lost and depressed.  But there are many younger people who never really found a place, never really learned how to work hard, and have kind of faded to the side.  They are home playing video games, they are taking too many drugs, they are often angry and causing trouble, they are having children they don't know how to take care of.  These are from places and families that were doing OK before, but now many of them can't keep up, can't find a way to really be independent.

There is also a third group that is under the radar, and very difficult to talk about without sounding mean.  These people didn't exist fifty years ago, but they do now, and they are very expensive.  They are people who would not be alive except for the fantastic progress in medical care.  Some of them were pre-mature births, some were from in-vitro multiple births, some were kept alive by amazing interventions, and others have illness that were previously fatal but now medicine can keep people alive, but not really very healthy.

I don't mean to imply that these people shouldn't be alive, or that they don't appreciate all that has been done for them, but there are many more like them who are in pain, have severe learning disabilities, ADHD, and other major handicaps.  Many of these people can't work, and they begin to get disability payments and complex, expensive medical treatment at an early age, and while it is good to have them around, and their families mostly love and care for them, it is very expensive and very time consuming.

As of right now, I don't have an answer for all of this.  It will probably take more than just me working on it to solve these problems.  But they are here, and they are getting worse, and no one is really paying attention to the magnitude of the problem.