Child's justice

Any therapist or good parent knows it’s destructive to tell a child not to have a feeling that he has.  Active listening and empathy show respect for the ultimate, idiosyncratic legitimacy of the child’s emotions.  If a youngster “hates” his teacher, there is some real, even physiological, meaning to his expression.  If she is uncomfortable around her uncle, hopefully her feelings are not minimized.

Not only do we respect the child’s feeling, we also help him discharge it with congruent meaning.  If he is angry at his teacher, he rails against his teacher: We don’t tell him to erase the content-target of the anger and substitute a safer one: “You shouldn’t be mad at Mrs. Hull.  Why not instead get mad at that bully who moved away last year, or at this ball or this punching bag?”  What we do is follow some unarticulated law of human nature that says to honor the child’s core “selfobject needs” (Kohut) for relationship we must deplore their breach.  Consciousness has a connection to other consciousnesses that it doesn’t have to nature.  We must call the wrong to task – the wrong of someone who hurt us, the wrong of someone who wouldn’t hear us decry the wrong.  If we don’t, we dilute the meaning of positive human connection for the child, and abandon him with injustice in his mind and heart.

But what if the child doesn’t know or remember what she is frustrated about, carries a faceless rage?  The relationship breach or disappointment has been lost to mind.  It may have been subtle – a parent’s promise that couldn’t be kept and therefore couldn’t be expressed by the child.  It may have been a conversion of emotion, hurt to anger – a role model older brother joining the military.  Or parents failing to perceive, and therefore encourage tears about, the tragedy of loss of a pet.  The feeling can’t find its true target.  But does that mean it can now be deflected, or “corrected,” or outlawed by the parent?  Aletha Solter talks about “pretext” or overblown feelings in her “broken cookie” idea.  A toddler may wail to the heavens over a small upset.  We must not condemn this exaggeration: It is appropriate to some inner truth.  The best we may be able to do, barring sophisticated recall by the child, is assume a true reason, which Solter says is the accumulation of past breaches, unexpressed hurts, that in their build-up explode in a cookie.*

A final puzzle piece to our child is that loss of emotional justice is loss of self, a painful splinter of the lost.  One can feel it happening: I remember repressing (not merely suppressing), as a youngster, pain of dejection when promises weren’t kept, and the slipping away of my meaning and value that accompanied it.  If we are ever to be enlightened enough to banish the phrase – “Get over it” – from human thought, this is where it should start.  The child cannot get over “it” because it has made her a hollower person.  And if you believe she has gotten over her loss, this is because you believe you have gotten over yours, and are passing on the lack of compassion from “I to thou.”

Interestingly, we see the adult, twenty or thirty or forty years later, and we want her to “manage” away her anger.  The dark side of the moon – all the unexpressed, faceless breaches in her young past – is unseen, doesn’t even exist.  We want her to flow in the upper atmosphere of her adulthood, when she needs to find the splinters embedded in her childhood home, pull them out, send them to their long-delayed target.  That is justice, and some peace.

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* Aletha Solter at The Aware Parenting Institute -- http://www.awareparenting.com/.  "Broken cookie" idea, from her article "Understanding Tears and Tantrums."

The real diagnostic axes

One day, not long ago, as I was singing a little sea chantey lament – “O why couldn’t I be a social worker?”* – I conceived this theory:

There are two axes of psychological dysfunction: injury in the mind-body and injury in development.  The two are always intertwined and mutually present.  And following the originating causal irritant (internal or environmental), each axis causes and exacerbates the other.  A corollary of the theory is that if a person has been psychically injured and acquires depression, anxiety, dissociation – neurosis or psychosis generally – he will also succumb to psycho-developmental failure at some level.  That is, failure to develop, mature, grow to genuine adulthood.  Fleshing out this idea, it would be true that many or most adults, even the brightest and highest, will not have ascended to true adulthood if they did not heal well from, basically exorcise, their childhood derangement.  They will be faking it unawares, living a front behind which lurks the undeveloped needy and pained child.

Another corollary is that in general, this developmental flaw leads to some level of personality disorder.  To live out of sync with one’s chronological timeline (to be, for example, an immature child in an adult Borderline’s body; to be an unloved little boy in a brain surgeon’s body) requires a seamless defense “attitude” which is the equivalent of a personality disturbance.  Therefore, as almost all of us were injured and not healed in our childhood, most all of us have a personality problem.

The extreme, and therefore most easily understandable condition in which psychic injury impedes development and grows an adaptive personality is early trauma.  Lenore Terr studied personality differences in individuals who suffered “type 1” (discrete) and “type 2” (protracted) trauma.  The latter associates with “interpersonal dependency” personality features.  She wrote:

“Personality takes a more extreme deviation when the trauma is long-standing or frequently repeated.  Instead of the relatively subtle personality rearrangements that a child will make after a single event, the reenactments of long-standing or repeated traumas pour out of the child so thickly, so frequently, that they amount to massive distortions of character.”  (Too Scared To Cry, p. 268).

Judith Herman, MD, in Trauma and Recovery, strongly suggests that “complex post-traumatic stress disorder” (her own conceptualization) is often mistaken for borderline, antisocial or histrionic personality.  She wrote:

“Survivors of childhood abuse often accumulate many different diagnoses before the underlying problem of a complex post-traumatic syndrome is recognized.  They are likely to receive a diagnosis that carries strong negative connotations.  Three particularly troublesome diagnoses have often been applied to survivors of childhood abuse: somatization disorder, borderline personality disorder, and multiple personality disorder.”  And: “Patients with all three disorders also share characteristic difficulties in close relationships.  Interpersonal difficulties have been described most extensively in patients with borderline personality disorder.  Indeed, a pattern of intense, unstable relationships is one of the major criteria for making this diagnosis.” (p. 124).

But if we can see that repression of the self-feeling – of one’s holistic energy – however it is caused, must take the real self off-line, then off the developmental timeline, and force a replacement identity, the door is open for any early pathogenic insult to lead to personality disturbance.  A shaming father who shuts down his son.  A narcissistic mother who glorifies her daughter’s talent while debasing her spirit.  Early and continued substance dependency.  Familial factors causing a child’s shyness or dissociation or anxiety (see blog post “Anxious Personality Disorder”) or ADHD.  I have seen a handful of men over the past two years who presented an inextricably integrated syndrome of attention deficit, hyperness, and boyishly immature, clueless behavior.  One man, a hospice nurse, welcomed a new employee with a large poster featuring sexually explicit humor.  This was not social gaucheness but an “ADHD personality” as immature and ego-syntonic as any Borderline’s.

This post will not be the place where I explain in depth my grasp of personality disorder, or my conviction that development aborts when the child’s needs are not met and the pain and reality of it must be repressed.  Though I will mention, with sadness, my experience with “Herbert,” a sixty-five-year-old who began a life of drinking at age five – when he would sneak sips of beer during his parents’ alcoholic parties – and didn’t emerge from it until he came for therapy as an old child.  Child, not man, because he had slept, dissociated and inebriated, through his entire life and never planted the feet of a growing person on the planet the rest of us share.  He died a few years after I saw him, curious about what had happened to his life.

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* Social workers (LISW) won the turf war against licensed counselors (LPCC) in Columbus, Ohio, and so it is better to be a social worker.

Immanence

Therapist Jean Jenson disputes a client’s claim that she was “abandoned”:

“If George leaves Joan as a result of their relationship problems, she will feel the abandonment of the child she was when her parent(s) blamed her instead of comforting her, as well as any other experiences of abandonment that occurred in her childhood.  She will cry her heart out and her friends will most likely sympathize with her, agreeing that George has abandoned her and reinforcing the idea that the depth of her trauma is appropriate.  If, however, Joan has been doing childhood grief work, she will know that, in fact, what she is feeling is the heartache of her childhood abandonment – that the pain of the loss of George is different from this despair.  She will understand that George has not abandoned her, as abandonment implies a dependency upon the leaving party that is true only in childhood.  What George has done is to leave.  There is pain when we are left, yes, but abandonment is far more than merely being left.”  (Jean Jenson, MSW, Reclaiming Your Life, a Step-by-Step Guide to Using Regression Therapy to Overcome the Effects of Child Abuse, p. 43.)

Paul Vereshack explains the “time pebble”:

“These are the childhood phrases and feelings which . . . lie scattered on the beach of adult conversation.  These TIME PEBBLES enter the therapy room with great power, disguised as present processes.  If we read them in the present context and don’t realize they come from the past, they can throw us completely off track.  Once we realize they represent a past feeling fastened onto a present process, we have a major key to the unconscious.  TIME PEBBLES . . . enter the present therapy process in the form of key phrases which have a high feeling content and a simplicity which feels childlike.”  (Help Me – I’m Tired of Feeling Bad, chapter 22.  Online book at www.paulvereshack.com.*)

A woman, in one example, repeats the phrase, “I can’t do this” as she begins her descent into a painful feeling.  The therapist divines that she is speaking with an unconsciously forked tongue, at once crying her rediscovered terror of childhood incest and naming her resistance to facing it in the here-and-now session.

Both clinicians are identifying words or phrases that reveal the immanent child’s experience and the “outer” adult’s resultant misperception or avoidance of reality.

Recently, a client with a breadth of childhood trauma and neglect that eventually produced pseudo-schizophrenia – malevolent voices and constricted affect along with full insight and functionality – said he is afraid to express his feelings to anyone for fear of “getting in trouble.”  Donning Jenson’s and Vereshack’s hats, I disputed the time pebble.  Adults, I suggested, don’t “get in trouble.”  They suffer consequences.  It is the child – abandoned and stripped – who feels the sheer dread and impotence of being condemned before absolute power, of being “in trouble.”

Familiar with this client over several months, I was able to hear the boy speaking through the adult corpus.  It’s not always easy to do.  In a second example, a man insists that his boss “hates” him.  Vereshack probably assumed that “hate” was an inappropriate attribution to an employer, and was therefore his client’s projection of past injury.

But what if we don’t hear any words that unmask the child?  What if our client is verbal and sophisticated, able to psychologize tit for tat with you?  Where will you hear the proof that this screamer or philanderer is a boy in man’s clothing?  These questions matter when there is the need to save the adult victim from his defeated child – my client – or to have compassion for the adult perpetrator’s rageful child.  And this need emerges when you can see that the child is more powerful than the adult, more accessible, more starving for help.

Listen for the mis-definitions, archaic thoughts – “I am abandoned,” "I'll get in trouble," "he hates me" – for the time pebbles that can carry you back to the original hurt.

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* I am very uneasy about citing Vereshack.  His book contains some astonishing (and astonishingly honest) revelations of past clinical misconduct, as he wrote it to present his defense before the College of Physicians and Surgeons of Ontario in the early ’90s.

Lost adolescent

What to do when you agree with a mother that there’s no normal therapy that will help her immaturely two-dimensional, tantrum-obstinate, personality disordered son?  His dependency on her only super-charges his regression and his fury.  But independence?  Can you send him into a world which is so far over his head he cannot comprehend it?

This is where you need those old country estates of early schizophrenia lore, where lost souls somehow found a groundedness, left to walk the peaceable fields, garden, regress to feces-fiddling babyhood under the watchful eye of R.D. Laing’s cohorts.*

Is there spirit-shock therapy?  “Holding therapy” that would forcibly restrain all escapes from Self until the spirit turned and clung like a baby feeding and breathing for the first time?  Can I do that in fifty-eight minutes a week?

No.  The solution, clearly, is to pick up one of those psych books where the writer, Jesus-like in wisdom and healing, describes his therapy of one to three times a week over two to five years.  Or rather, elaborates his theory and avoids describing the actual daily moments of change, the “crisis of healing.”**  You ask yourself: How did he keep someone in therapy that long?  Is he that paternal, that good-looking?

And holding the book, you feel good for a short while.

With a few years under my belt and over the hill, I am cocksure enough to imagine (but not try) crash-and-burn therapy.  “Young man, you are bizarrely fucked up and there is no help but to face the truth.  You did not grow up the right way.  You will have to get out of this timeline, immerse yourself in the child, the baby, burn through the anger and the fear.  You will have to lean on me, as if there is nothing but leaning, let your infantile needs be expressed, forget about what’s correct.  And in this temporary hellish paradise, we will find some you that feels OK because it is held, so held that it will be held for the rest of your life.”

Then, you throw away the book and pick up Bettelheim’s, in which he said: “I speak here of the child’s private world. . . .  Each of us is implying in his way that one cannot help another in his ascent from hell unless one has first joined him there, to whatever degree.”***

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* Robert Boyers and Robert Orrill, editors, R.D. Laing and Anti-Psychiatry, 1971.

** Steven Levenkron created "nurturant-authoritative psychotherapy," which he states is a fancy term for reparenting.  He writes about anorexia, obsessive-compulsive disorder and self-mutilation from that paradigm, which values the client's crisis of healing: breaking through the defensive alienated-defiant and pseudo-independent shell to the regressed and dependent -- and therefore reachable -- child.  Though Levenkron claims an extremely high success rate with anorexics, he is best known for his famous client, singer Karen Carpenter, who died of heart failure related to ipecac poisoning.

*** Bruno Bettelheim, The Empty Fortress, 1967, p. 10.

Hope as a tree

Picture a tree that has grown in an inhospitable terrain.  This is a symbolic tree, that doesn’t require impeccable botanical science to make an analogy.  To survive in the dry, impoverished soil it has extended roots far deeper than normal.  One could say it has grown “tough,” learned to do without, but in fact it is fragile, infirm.  Let’s say someone comes upon this tree and gives it water and some nutrients.  It perks up, brightens, bounds taller.  And if the hippies were right that talking to plants is vitalizing, it responds to cheery words with a mini-flourish.  However, after a while the person leaves (other trees to hug, promises to keep).  The tree’s green light dims, it languishes, loses a good bit of the spirit that came with birth and solitude, survived experience but has now suffered shock: today's resonance with its deep-rooted loss.

Maudlin, yes, but I believe this picture describes the actual state of hope in someone who grew up in a dry and failed land.  His roots are sunk deep into his past, while others’ roots don’t go as deep, are more in the “here and now.”  His leaves play in the breeze but are more drawn in as they are inexorably pulled by the message of the soil, which is loss.  The sun is golden, the day is promise, but the message of the soil is loss.

An eighteen-year-old client tried to fool himself recently.  I had mentioned that of all the teenagers I’d seen in my day, he spoke the least about family – hardly a word in one year.  Disenfranchised foster kids, sullen delinquents, tossed-about itinerants usually would be very conversant about addicted or estranged or loved parents, savior grandfathers, stepmothers, half-siblings, uncles.  And though he lived with both parents alternately, there was not a word.  The self-deception was his claim to enjoy the "quiet" at his father’s home (mother was written off as their relationship had always been cold and superficial).  Father was a depressive.  Spotting a possible contradiction, I mentioned something he had said half a year earlier, that as a little boy he had tried to hold his disintegrating family together by getting them to talk, to play board games.  He had failed.  Was this, I asked, why he could tell himself he enjoyed the quiet of his father’s depressed home?  Yes.  He had failed.  And he had given up.

We talked about the “stain” of a child’s giving up.  With an inward notice, I said, I too could sense the changed landscape from loss of hope's echoing through my earlier life, and could see young life scenes that reflected it.  The stain spreads and denatures the soil upon which everything grows.  The roots remain deep in it, the hands draw in, the trunk infirm even when a lovely girl offers the nourishment of a smile, an invitation to a party.  Hope can happen, or can try, but it would be like a tree leaping into the sky, leaving its ground.  Yet, it can leave.  Or rather, it can find new ground, new nourishment.  Accept the invitation, breathe in the smile, extend your roots to another.

New Year thanks

This is to thank those individuals who have clicked onto my blog in the few months since its September 2013 birth.  A little “paranoia” makes me wonder how many people actually read entire articles, which I know are pretty heavy cream.  I also know that my writing comes from extremely confused motivations within me, a strand of which is a narcissism that magnifies the value of my ideas in my own mind.  There is, however, a countervailing strand which guts the significance for me nearly as soon as I upload a post.  Upshot of these and other machinations is that I have gratitude but no expectations.

One item which I can’t help but mention is that outside of one response which I fairly solicited from another therapist-blogger at the beginning, there have been no “comments” to my articles.  That is partly comfort-making and partly deflating, but I don’t understand it.  I can imagine things, though: Maybe others see psychology as a wet blanket as I do, but for those fine moments in sessions.  Beyond those, I would much much rather be living the quiddities (see blog entry of September 27) than sitting on a mirrored cushion of evaluation, a distancing cushion of thought.

A major roadblock of mine is the problem of meaning.  I will be working on it in the coming year, especially as it restricts my “literary enthusiasm.”  Then again, earlier in the day I glanced at Dr. Phil’s website, the most gaudy pandemonium carnival of pop psychology I’ve ever seen.  I would rather be a man of few words.  And much less advice.

For now, I’d like to welcome (with some nervousness) the occasional input, as question or original insight.  I still enjoy learning things in the field, and believe that we could share and synergize, maybe even find some new discoveries.

Dry humor, or wet seriousness, for the end of the old year

In February of 1958, classical music composer Milton Babbitt published his notorious article, “Who Cares If You Listen?”*  The article expressed indifference, or worse, to the listening audience who had hidebound tastes,** could not grasp the complexity of “serious” and “advanced” music, meaning serialism, and didn't like it.

There are psychotherapists with a similar sense of rectitude, which might be expressed: “We know what you need, what is good for you, and what your best is – whether you want it or not, and what your worst is – whether you want to ‘go there’ or not, and we will promote the ultimate good and cleave to the truth irrespective of your liking it or your improving.”

I know about these imperialists because I am sometimes one of them.  And I hope that very many of my fellow therapists are, too, because I’d hate to think we are pusillanimous dance partners whose definition of “help” is to masturbate our clients’ defenses.

Who masturbates their clients’ defenses?

* Therapists who practice the latest vogue, “strength-based counseling.”  This politically and bureaucratically correct inebriant, according to a University of Miami course outline, “represents a new paradigm in the field: from viewing clients primarily through a deficit lens, to a view that focuses on client strengths.”  “The aim of a strength-based counselor would be to identify and amplify client strengths, not on diagnosing problems.”***  See Appendix for an example of the strength-based approach.

* Therapists who assume that strengths are strengths, when they may be weaknesses.  Hope is a strength, unless someone continues to prostrate herself before a toxic parent, hoping for love that parent is incapable of.  “Hyperfocus” and hard work are strengths, unless you are hyper-avoiding the feeling world within and around you; unless you are struggling to be acceptable not worthless.  Kindness is a strength, unless it is the false self or your perfumey armor over shame.  Reasonableness is a strength, unless it is what grew over the corpse of your emotions, the fire of a feeling self.

* Therapists who believe in “solution-focused brief therapy,” another lobe job**** philosophy that believes pointing a rudderless ship to shore is good help.

Describing my paradigm at the beginning of a therapy – after the psychosocial assessment or a good listen to the client’s distress – I am saying that your problems fall within human nature as I understand it.  You have been hurt and have grown a wounded self.  The past is not the past, but the roots beneath your feet.  Time doesn’t heal – it masks and suffocates, abandons, intensifies, twists, corrodes.  Rarely if ever do clients demur from this benevolent approach.  What they do, sometimes, is request a psychiatric referral then substitute medications for therapy.  But in twenty years the only contrarian position I’ve heard has come from a student of counseling who was averse to the idea that one cannot smart-think one’s way out of mental pain.

And that long experience – that “my” people accept where I’m coming from – makes me wonder: Are there legions of strength-based, and solution-focused, and think-heavy (cognitive) therapists out there?  Clinicians who convince real people that capitalizing on their strengths will banish their ills?  Who convince real people that a new behavior or plan will change their different nature?  Who complexly out-reason their inferior-thinking clients?  Could it be just a reification of an echo – the way celebrities are famous for being famous – that the culture of psychotherapists buys these ideas, popular because we think they’re popular and therefore blessed?  Underground, are we actually authorities, brain surgeons in velvet gloves, Rachmaninoffs in Babbitt’s clothing?

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Appendix: Strength-Based Counseling

A man enters his strength-based Primary Care Physician’s office and says, “Doctor, I think I have cancer.  All the signs are present according to WebMD and my family history going back four generations.”  The doctor reassuringly says, “Don’t worry.  Let’s not focus on the negatives.  I hear you play a killer game of backgammon!”

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* http://www.palestrant.com/babbitt.html – Babbitt's ridiculous article that kills as it bores.

 

** That is, they preferred this: http://www.youtube.com/watch?v=QNRxHyZDU-Q to this: https://www.youtube.com/watch?v=_fkx5IYfiPs.

 

*** umbh.med.miami.edu/.  What terrible grammar!

 
**** “Lobe job.” The term comes from a science fiction story I read as a teenager.  A man in suspended animation wakes up in the far future.  Instead of finding an advanced civilization, he sees a decrepit cityscape, fallen to ruin from centuries of neglect, and nary a soul about.  He comes to learn (if I recall, in a disastrous way) that most of the population has succumbed to the pleasure of fantasy lobotomies – "lobe jobs" – by which they live out glorious lives of adventure, intrigue, etc. while lying comatose on a table.

 

Fantasy in f minor

I wanted to mention that while I sometimes reveal, in these posts, neurotic and dynamic features of my makeup, there is much that I will never say to anyone, that I will carry to the grave.  That content is not indiscretions or other colorful stuff, but what I know about the formative structure of my identity – the seed as it was and as it foretells the rest.  The fact that I can’t be alone in having “places” one does not want to dwell on – or dwell in – is a lesson about the shortcomings of the “primal” approach to psychotherapy that I cut my teeth on and still respect the most.  That is the approach that brilliantly questions the False Self and all defenses, sees Pain as the river that carves our landscape and undermines our subterranean self, and understands that repression is pathogenesis of mind and body.  I believe the best argument against primal purity is, “You can’t go home again.”  Pure openness – defenselessness – would be the untied balloon that deflating, lurches back to its formless, inchoate self.  Even exorcising his or her pain would not be enough.  Even counting on – a paradox the primal folk silently endorse – the “outer adult” to hold the cleansed-by-fire inner child would not be enough, if there was never a foundation to stand on.

Though physicists launch their minds into the universe while standing on a self-swallowing base of quantum uncertainty, free will determinism and ontological anarchy, I find my work slightly, and my writing significantly, braked by both the dark gooeyness of my foundation and the question of best psychology.  Sometimes I think of a person as an egg, whose shell is the defense system (drugs, denial, intellectualization, depression, workaholism, masturbation, violence, ad infinitum).  He is imprisoned within the shell – can’t really see out, can’t really live – but is not viable without it.  I wonder, sometimes, if best healing – by God and psychotherapists – would be to hold the hurting person in your arms while covering their eyes against their deepest truths.

A bigger problem for me is my own unsayable, which obliquely conforms to Yalom’s insight that in group therapy, so long as the members avoid discussing the elephant in the room – whatever the big issue is – nothing else of importance will happen.  While there are different subjects I may have a useful perspective on – such as anger management versus resolution, or client loneliness, or the narcissistic-sexualized front of my 21-year-old client – I often find these issues eclipsed by the dark sun of my own existence mystery.  And as my typing is invariably gravitationally drawn to the darkest forces, I’m pulled away from these livelier planets.

http://www.youtube.com/watch?v=5s2mtaQZQn0 – and Merry Christmas.

Tics

I’ve just returned from a very brief vacation with in-laws and young nephews, where the subject of tics did not come up.  As I am “the therapist” in an extended family with problems, I was struck by a distressing historical parallel which I helped create, but may now deconstruct, slightly, by this article.  In the late ’50’s and early ’60’s, I was a youngster with anxiety, tics and other nervous behaviors including a hideous blight of trichotillomania – hair-pulling.  I regularly chewed holes in my tee shirts, churned my neck, bit my lower lip bloody down to the nerve, sewed with thread patterns in my thumb, well callused by continual gnawing.  The bald was a massive, irregular continent shape.  No one said a single word to me, ever, nor was any therapy or other treatment ever provided.  My uncle, formerly an obstetrician and at the time a bona fide psychoanalyst who saw patients at his Park Heights Avenue condominium, never talked to me, and maybe not to my parents.  And they said nothing, but eventually took me to a hairpiece maker who fabricated a custom toupee.  A mediocre story writer couldn’t have come up with a more obviously condemning symbol for “cover up the problem.”

A psychotherapeutic throw-back or curmudgeon – take your pick – I pay indifferent homage to genetics’ likely implication in some psychological disorders, and generally consider the notion a cop-out that deserves to be laughed then kicked out of court.  Much more active than genetics are influences of powerful forces that are in the hands of parents or others.  Following is the abstract of an article, “Relationship of maternal and perinatal conditions to eventual adolescent suicide,” published in the March 16, 1985 edition of The Lancet:

“In an investigation of a possible relationship between falling perinatal mortality and rising rates of adolescent suicide, 46 risk factors from the prenatal, birth, and neonatal records of 52 adolescents who committed suicide before age 20 and 2 matched controls for each subject were analysed blind.  The results showed statistically significant differences between the suicide victims and each of the controls and no difference between the controls.  Three specific risk factors were shown to have a powerful capacity to differentiate the suicides from the controls: (i) respiratory distress for more than 1 h at birth; (ii) no antenatal care before 20 weeks of pregnancy; and (iii) chronic disease of the mother during pregnancy.”

Respiratory distress at birth along with an impaired mother, and mothering, leads to suicide thirteen to twenty years later.  Psychology is biology the younger we are, a fact that sublimates (I mean this more as the chemical definition of refine or purify, not the Freudian take) “blame” of parents to non-blame, but leaves “responsibility” undisturbed.  And the responsibility is: Don’t blame the goddamned genes.

I can tell you what happens when tics, and the person, are ignored.  At age 30, working as a typographer in Sarasota, Florida, I kept in my wallet a handwritten list of approximately twenty tics that I both cherished, perversely, as my identity neurosis and desperately determined to abolish.  Included were thumb-deforming squeezing and clicking; snapping upper and lower rows of teeth together; neck churning; brusque sniffing; finger stretching; foot churning; flicking back of teeth with tongue; sliding, in dreamy patterns, tongue over teeth; intensely compressing nostrils by muscular contraction; swallowing air; chewing skin off fingers and flicking it across the room.  Though the tip of the neurotic iceberg, these acts were essential to my identity, like skin, as they kept submerged the ghosts that, paradoxically, were the dreaded real self, the ungrown child.  In time, I mastered most of them by brute and depressingly vigilant force.  But right now, thirty-two years further on: The thumb is squeezed, and clicks.

Picture this truth: Tics are the compressed energy of impossible silence in the face of insane loss.  A father who does not talk to his son is the world gone wrong, essentially killed.  Say goodbye to that world, but without words, without sympathy.  Dull or divert your eyes from this grandest of all sights, because nobody cares.  And many years later, see the tic as the history of all the unsaid, un-had, ungiven.  How mute it is!  And because it should never have been mute but instead the language of meaning, color, life, it is awe-fully eloquent.