Читать книгу Dynamic Consultations with Psychiatrists - Jason Maratos - Страница 17

JM thanked the doctor for the full presentation, but in view of the limited information available for Ms. A's early life history, he asked the doctor to clarify if there were any more data about this important period in her life. The doctor responded that Ms. A was reluctant to talk about that period in her life. Ms. A remembered “repeated scolding” but denied any abuse—physical or sexual. Ms. A spent most of that time looking after the young “siblings” of that family. JM invited the doctor to give some more information about this woman's experience of living with this family, such as “what was it like being adopted?” The doctor clarified that her state was not one of adoption; she was expected to work for the family in return for meals and shelter. Later, the doctor explained that Ms. A had described her experience as a form of emotional “torture” and had explained that the “mother” treated her as a maid and not as a family member.

JM asked if this was slavery and the doctor responded that Ms. A perceived it this way. She further perceived that she lacked parental care and that her childhood was deprived. JM inquired if she was educated, and the doctor replied that she was not allowed to go to school, and the family did not spend any money on her education. JM asked about her status as a worker and if from the age of 1 she was an unpaid worker for this family and if the deprivation of education was common at that time in such villages in her home area. The doctor responded that she was an unpaid worker and the absence of education was common in many poor families at that time in similar villages.

JM asked the doctor to clarify what Ms. A's perception of growing up would be. Would she see herself as having a similar life experience as the other children in her “bought‐in” family? Did the other children receive education? The doctor responded that she would see herself as disadvantaged because the other children did receive education. Ms. A. often “grumbled” that her biological siblings received better care that she did. She knew who her biological family was. JM said, so she was aware that she was not the child of the family in which she had been sold. Yes, because she was in contact with her biological siblings. JM asked about her understanding of why she was sold and not any of the other children. Ms. A. did not have a clear idea of why that was the case. She attributed the sale to poverty and to the fact that her elder biological sibling was needed to look after the other children because the parents had to work to sustain the family.

JM summarized the predicament of Ms. A as that of someone whose life was far from ideal but not unique in that cultural setting. She lived with her daughter's family (not unusual in that culture), she had been divorced (not uncommon in today's city—or elsewhere), she remained in contact with her children, and she was unable to work (5 years from retirement age). Her situation could not completely explain her depression. Not many women in her situation suffer from recurrent depressive illnesses and gain hospital admissions because of suicidal ideation. One needs to look deeper and further to gain a genuine understanding of her depression. Another important feature of her condition is that Ms. A improves rather quickly after admission to hospital. She improves before any medication has time to cause a lift in mood.

JM inquired what the doctor's understanding of why Ms. A responds in this way to her predicament. The doctor replied that she has no role in her daughter's family. She did have a role when she was bringing up her children and her grandchildren; since she lost her job, she lost not only a role but also the social contact and she felt lonelier. JM replied that she had to contend not only with the absence of a role and of connections but also with the loss of them (role and connections) and that she was becoming more isolated and without a purpose in life. JM asked if her connections were related to her “feeling useful?” The doctor said yes.

JM noted that it seems that when she lived with her daughter, she was fulfilling a number of functions; she was useful and in return she had connections and a purpose in life. With the loss of these functions and connections, she not only feels redundant and isolated, but she is without a useful role and without meaningful connections. JM asked if she has any other connections, such as with friends. She is friendly with some neighbors with whom she plays cards sometimes, but this activity “bores” her at present and so, she does not seek their company as much. JM then stated so, she does not have any friends. The doctor replied, none at all. JM then said, and is this the reason why she is dreaming of returning to her hometown? Is she hoping that she will find some connection there? The doctor agreed with this. JM noted that her predicament is depressive; she has not managed the present transition in her life in a creative way and asked if she could have stayed with her daughter if she had managed the situation there more positively. The doctor said that it is common for grandmothers to stay with one of their children's families in that culture, and it would be possible for her to do so (live with her daughter). JM asked if the aspect of Ms. A's behavior that was making their living together difficult or untenable was known. The doctor said that she wanted her daughter to follow Ms. A's style of bringing up children. JM summarized then she was not respectful of her daughter's and her son‐in‐law's views on how they should bring up their children. She was critical of them. She would not accept the different way that they had decided to bring up their children.

JM responded that it is not only a matter of her beliefs about upbringing of children but it is also the matter of her actions. Ms. A insisted on criticizing and on influencing her daughter's family so that their family would be brought up in Ms. A's way. He then asked if she was aware that her intervention was going to influence the relationship with her daughter negatively. The doctor said that she knew of the effect that her behavior was having, but she insisted that hers was the right way. JM noted that although Ms. A's main need was one of being connected, her behavior was putting that connection in danger and asked if she was clear that her behavior was working against her own needs and that for the sake of doing things in the way that she believed was right she was endangering her relationship with her daughter? The doctor replied that she was aware. JM then responded, so she was consciously prepared to sacrifice her relationship with her daughter for the sake of struggling to do things in the way that she thought was right.

JM inquired how the doctor made sense that Ms. A sacrificed the most important thing in her life for the sake of doing things in the way that she thought (she felt) was right and what the point of conflict with her daughter about the bringing up of grandchildren was. And more, what was the nature of the conflict between her and her daughter? Ms. A's daughter felt that her mother was overprotective. Ms. A believed that her daughter should correct her children's errors, while her daughter believed that she should allow her children to experience the consequences of their mistakes. JM asked if there was a way of helping Ms. A to maintain the connection with her daughter by changing her behavior in relation to the grandchildren and if there was a way of helping her understand that her beliefs about the values of bringing up the grandchildren are connected with her own experience as a child. Ms. A feels strongly that the children's needs should be addressed in an immediate way, whereas her daughter was prepared to hold back. Can Ms. A's current behavior toward the grandchildren be linked to her own early childhood experiences? The doctor noted that when she was a child, Ms. A was aware that her needs were not addressed and only demands were placed on her.

JM responded that her own privation as a child remained a powerful force for her current behavior toward her grandchildren. It was emotionally impossible for her to allow what she perceived to be some privation in her own grandchildren. The meaning she gave to the current situation was a replication of her own privation as a child. Analytically it is important to see how she had not overcome the trauma of her early privation and that it was these feelings that were driving her (even to her own cost) to rush to meet the grandchildren's needs immediately. In this way Ms. A was attempting to overcompensate for her own privation, and this feeling was so powerful that living with her daughter had become impossible.

In view of this understanding, if Ms. A were to be receptive to analytical therapy, what would you set as the objective of therapy? Therapy would be directed toward resolving the feelings arising from her early painful experiences. JM concurred; she needs to mourn and grieve the deprived childhood that she had. After the mourning is complete, she will be more likely to be able to separate her own childhood experiences from the present experiences of her grandchildren. For example, her relationship with her daughter will be a lot better if she allowed her daughter to bring up her children in a way that her daughter thought right, instead of seeing that as a repetition of her own privation. She will be in a better position to allow her daughter to be the authority over her own children. She will be able to see that her grandchildren, being brought up in her daughter's way, are not being deprived in the same way that she had been when she was a child.

JM asked if there any chance that she may live with her daughter again. It was clear that her daughter will welcome her back. JM responded that there is a hope that if she resolves this mourning that she will be able to live with her daughter and have a life in which her need to be connected is more likely to be satisfied than it is presently. This change will address one of the main reasons for her depression. Once she has resolved that grief, she is more likely to see the separateness of her own experience from the experience of her grandchildren and she will be able to have a more contemporary life experience with her daughter. Ms. A is likely to feel that her grandchildren, being raised in the way that her daughter and her husband wish, is not a repetition of her own deprivation and that her grandchildren are having a pretty good life. Feeling like this, will make it easier for her to take a grandparenting role, which is secondary to that of her daughter. She will be a grandmother helping her daughter instead of going against her. This will enable her to adopt the new role of “the helpful grandmother” and will remove one source of frustration and conflict in the new extended family situation.

JM noted that because her depression has a large element that is reactive to the situation, an improved life situation is likely to improve the feelings of depression. It is fortunate that the relationship with her daughter is not irrevocably broken down and it is conditional. “Mum, if you respect my way of bringing up my children, I will welcome you to live with my family.” So the line of therapy could be two‐pronged: one line is to help her accept, mourn, and complete the grief about her own childhood experience and the second to point to the direction that she can strengthen the connection with her daughter (instead of threatening it with antagonism) and in this way remove one of the main sources of her depression.

JM noted that another aspect of her life is her need to develop other relationships not related to her eldest daughter and her family. She needs to have her own adult and separate connections and sources of support. If she remains with the only connection of that with her daughter and her family, this is likely to create serious difficulties. There is a high risk that she will become overbearing and overdemanding. There will need to be a separate focus on why her relationships with her own peers have not gone well. Relationships with her peers are a whole new chapter. My guess is that she breaks the relationships with her peers before they have any chance of becoming genuinely supportive. It seems that she does not have the patience to negotiate the relationships with her peers so that they become mutually supportive. Ms. A's approach is good in the beginning of a relationship, but she seems to break it at the initial stage without working at developing the relationship with her peers. She misses the opportunity of advancing the superficial relationship to make it a more substantial one. The doctor agreed to work with her in moving through her previous experience and on developing new relationships with her family and with her peers.

JM then noted that it seems that her difficulty in proceeding in the mourning process is reflected in her reluctance to even contemplate her early life experience. She needs to be shown that it is possible with a professional's presence and sympathetic understanding to undertake this painful mourning process. Her chances of moving on will improve if she completes this mourning process and accepts that the past was past and is not being repeated in the present. This has been an interesting case; thanks for presenting it so well.

Scientific Literature

This case is of particular interest because it highlights the long‐term impact of child selling. This is, of course, an abusive practice that was common in several countries during times of famine or other social privation. Children are also sold for sexual exploitation, prostitution, or for organ transplantation for a financial reward to, usually, the father. Most commonly the sold children are females. Surprisingly there is no scientific literature easily accessible on this issue. One can find the case of the sold child in the literature of Child Abuse and Neglect.

The other focus for this case is one of the “loss of role” and loss of connections in the later stages of life. References to “retirement” in more general terms (not only from gainful employment) are cited in relation to other cases in this work.