Author: lsblmft

Chronic Illness and the Family


It may be the idealized image of television shows, or perfect, ever-present pictures in advertising in newspapers and magazines, or just the plan hopefulness with which we all start our families. But most of us don’t plan to include chronic, life-long health problems in our family plan.

Our bodies are quite amazing creations, able to fight off disease, recover from injury, grow, age and change every day. We aren’t minds that have bodies attached, but we are instead bodies that think. We must eat, move, think, rest, work and love with our physical selves in mind. And for the most part, this natural rhythm of self-care makes life work.

But life isn’t smooth, and our physical systems aren’t perfect. Some of us will encounter injury, disease or disability that does not respond to time and care. For many of us, that process comes quite late in life, after the children are grown and gone, and our work life blessedly finished. But for others, this physical change comes much earlier, as a child, or teen, a young or middle adult. And suddenly life is different.


Chronic illness. It’s a disease, like diabetes, that robs the body of its natural resources and requires hourly attention to diet, activity and insulin. It’s asthma that can be quiet for days and weeks and suddenly constrict airways. Spina bifida, cerebral palsy, brain disorders, arthritis, paralysis, cancer, and blindness: the list of disorders, diseases or injuries that can change our lives is seemingly endless. None comes with our permission. But once it comes, if we want to keep our families and marriages healthy, happy, and productive, we must figure out how best to cope.

While those who live with chronic illness in themselves or close loved one have to create their own way to manage, there are some common factors when people find themselves faced with permanent life challenges. Perhaps one or more of these resources may fit you and your family now or in the future.

  1. Support. Being suddenly faced with disease or disability can be an enormously isolating experience; we feel overwhelmingly alone in our loss. Reaching out to others who have been there before us is a great relief to many. Local, in-person support groups or electronic on-line discussion groups are a wonderful way to break that isolation, find help, advice, and new friends who can walk the new journey with you.
  2. Education. Many of us have found the Internet and it’s endless resources both wonderful and awful: some of what we find is inaccurate and it’s hard to sort out which information is true or not. Finding the most authoritative sources of information about our condition is important and life giving. Medical libraries on-line, medical professionals, and research foundations may be the best places to start when researching a disease.
  3. Insurance companies. Believe it or not, most health insurance companies want to help you manage your disease so that you maintain or improve your symptoms. Many diseases have been shortened, improved or cured by the research done in clinical trials. Ask your physician if you qualify for research studies, and then be in touch with your insurance provider. You may find, as I have, that your insurance will cover an important, life-giving clinical study.
  4. Mental health care. As a psychotherapist who has been a therapy patient herself, I know how critical mental health care is to living with disease and chronic pain or disability. Reach out for mental and emotional support before you feel overwhelmed, and find a private, confidential healing place to think about your feelings, behaviors, relationships, and changed body. Internet directories like GoodTherapy.org are great places to search for quality therapists in your area.
  5. Spirituality. Nothing is more important to the long-term adjustment to change and disability than working within one’s sense of faith, belief, ritual and higher power. Faith and spirit can help one recreate a sense of purpose, meaning, self-care, self-acceptance, love and forgiveness in the midst of loss and change. When we can feel connected to a Being or community that loves us in the midst of our personal storms, we can experience a safe harbor for our hearts and minds.

Even with some or all of these important resources, living with chronic disease is a difficult and exhausting journey. Be sure you make time and space in your life for love, laughter, and joy, the things that hold families together. Despite the challenges, you may find life really worth living, together.

Personality: Does Birth Order Matter?

For generations, family members have noted the differences that naturally arise in children raised in the same family. How is it that John, the first born and only boy, seems to have such different personality characteristics than his younger brother, raised in the same house by the same parents just two years apart?  Good question!

Theories of personality abound. You may be familiar with some of the more popular models, often used in work or educational settings. The Myers-Briggs Type Indicator (MBTI), based on the four major personality styles described by Swiss psychoanalyst Carl Jung, is a favorite. The Enneagram, a model developed in religious communities and often used in spiritual direction, and other forms of personal discovery, is another.  These are models that seek to describe common types of personalities. Other models, such as the Big Five theory, attempt to describe personalities using the idea of common traits shared by human beings across the world, such as extraversion or neuroticism.
    
Whichever way makes more sense to you to describe human beings, by types or common traits, we have a collective curiosity about how people become who they are, and how much we can or should adapt ourselves to others and our environment.

How did I get to be the way I am? When my clients ask me this question, I answer this way:  our personality is constituted like a recipe, with three primary ingredients. The first main ingredient is our individual nature. We are born with a particular style of personality, inherited from our parents and our larger family system. It’s part of our genetic code, and forms the basis of who we become.  Our general sense of the world, our innate optimism or pessimism, our sense of humor; this basic personality is another thing we have inherited.

The second main ingredient of our personality is formed by the way we are cared for by our parents; it’s the nurture part of the recipe. Was our mother well nourished, healthy, and ready to become pregnant? Were our parents free from addiction, major illness or injury? Was our birth relatively normal? Were we welcomed into the world with joy and cared for with love? The way our parents meet our vulnerability, suffering and growing sense of self makes up the great majority of our personality relationship style.

If our parents or primary caregivers have enough sense of self that they can sacrifice and respond to our needs consistently, we learn to trust that others will meet our needs, and that others are trustworthy. We offer ourselves to them, and get care and love in return. In the research done on this concept of emotional attachment, about half of us get just what we need to feel secure. The rest of us learn some combination of security, anxiety and withdrawal to cope with inconsistent parenting.

The third part of our personality is made up of all the unique, individual experience we have in life and what we do with it. It’s the fall you took in second grade from school jungle gym, the trip to the hospital, and the cast that you had to wear through the summer. How did that fall affect you? How did it shape the way you think, feel and respond to the world? What happens, and how you chose to respond, makes up a large part of your personality.

What about birth order? I think it fits in this third “what happens to us” category of personality development. While research is still battling it out whether first born children actually are more independent than their second born siblings, therapists and other social scientists have found a common pattern in family position that seems to fit many families, at least in Western cultures. In general, first born and only children are commonly more self determined and disciplined, having been born into an adult system and most closely associated to adults, even as infants. The second born child is less connected to the adults in the family, and if followed by a third child, may feel a bit lost in their parents’ strong relationship to the first born and emotional focus on the baby of the family. The farther away from the parent system, the more independent and even rebellious that child may become (Sulloway, 1997). Additionally, the more older siblings a child has, the more accustomed they often become to letting other people lead, and can more easily go “with the flow” than those born first.

Family therapists differ in the amount of importance they place in this theory of birth order, but most will inquire about how a client’s family is constituted, and where in the family their client “fits.” Why it matters at all is that it may help people better understand some of their unconscious preferences for friendships, marriage partners, relationship styles, and even how they may connect to or discipline their own children. It’s all just part of our individual personality recipes.

Sulloway, F. J. (1997) Born to Rebel: Birth Order, Family Dynamics, and Creative Lives. New York:
Vintage.

Losing the Boundaries

I’ve been reading about blogging, and it seems that I’m not doing it right.

Those in the know about such things tell us writers, mostly in their blogs, that to blog is to create a personal online community, one which is thirsty for the writer’s words and self revelations; writing that steps toward the daily Diary or Journal, and away from more sedate Opinion or Editorial. The most successful of blogs these days – and it seems to change every day – drone on and on about the personal trials of having a newborn, or looking for a job, or recreating the work place, or reinventing the government, or the economy, or the Church. Again. These exemplars are often writing on the fly, with nary a concern for punctuation, spelling, brevity, or privacy. It’s all about capturing the reader, and capturing as many as possible.

You may have noticed that I’m not much of a rebel when it comes to the niceties of the published essay. I have spent far too many years putting words into sentences to drop punctuation or spelling for the sake of being current. In fact, I hate it when I find a mistake after I hit the Publish Post button. And having a couple of deadlines to meet (in newsprint and online) makes me very unlikely to post here too often.

But for this writer/preacher/therapist to blur the boundary between self and audience, to say more than is prudent, to share information that I’ve been asked to hold as private: that’s a scary thought. 

To have good human relationships, in part, means to know that there is a real difference between me and you. And the differences need to have breathing room, space to breathe, and respect from each of us to flourish. If I blather on and on about just myself in this space between us, there isn’t any room for you. If you trust me with personal, sensitive information and I write about it, I’ve broken your trust. Even if someone else wants to read about it for the drama of it all. Even if it seems entertaining.

So, I guess I’ll be at the back of the blogging pack on this one. I won’t write specifically about any of my clients. I won’t share anything of my family without thinking several times and then asking permission. I’m going to stay away from the most personal in order to say more about the shared. I’m going to be a blogger who posts less frequently, does more editing, and points more often beyond my little life to the world beyond.

Call me a slacker. It’s just how I roll. Or write. 🙂

Go To the Limits of Your Longing

God speaks to each of us as he makes us,
then walks with us silently out of the night.

These are the words we dimly hear:

You, sent out beyond your recall,
go to the limits of your longing.
Embody me.

Flare up like a flame
and make big shadows I can move in.

Let everything happen to you: beauty and terror.
Just keep going. No feeling is final.
Don't let yourself lose me.

Nearby is the country they call life.
You will know it by its seriousness.

Give me your hand.


Rainer Maria Rilke

Book of Hours, I  59

The Modern Novel: Why bother?

I spend a good amount of my free time reading novels. It’s a past time that is more like a personal compulsion; this form of storytelling has grabbed me ’round my neck since I started devouring The Bobbsey Twins. This need to read turned me into a collector of books, a lover of dictionaries, an English major in college. I care about this art form. A lot.

So if you are a reader, too, you may share my enduring heartbreak over what happened to the long form of storytelling that is the novel in the 20th century. Certain writers broke form, and turned the sweeping, luxurious narrative into a broken, piecemeal, fragment of story; a weakened stream of image, word and punctuation. What could have been beautiful became a stumble through words until you want to die from boredom.  (For me, the names of such writers as James Joyce, William Faulkner, Ernest Hemingway, and David Foster Wallace send me running for the door. ) The intelligentsia – the critics and editors and publishers – all lauded this development as a maturation, a transition to new greatness, and we the hapless readers were forced to endure it like bad medicine. I did what I think most regular readers did: I read everything else. There is no shortage of writers who can still write a good story.

Hence, my joy at reading the TIME news magazine cover story about author Jonathan Franzen, whose latest book, Freedom, is due out shortly. Finally, a popular literary fiction writer who is understanding the need for storytelling. Here’s what he said:

It seems all the more imperative, nowadays, to fashion books that are compelling, because there is so much more distraction they have to resist. To me, now, to do something new is not to develop a form for the novel that has never been seen on earth before. It means to try to come to terms as a person and a citizen with what’s happening in the world now and to do it in some comprehensible, coherent way.  

We are so distracted by and engulfed by the technologies we’ve created, and by the constant barrage of so-called information that comes our way, that more than ever to immerse yourself in an involving book seems socially useful. The place of stillness where you can actually go to write, but also to read seriously, is the point where you can acutally make responsible decisions, where you can actually engage productively with an otherwise scary and unmanageable world.                                      (8/23/10, p. 48)

So, here’s to Franzen’s perspective: a hope for the return of the value of story telling, the grand, wide sweep of a world that readers in the 18th and 19th centuries simply assumed. English majors, UNITE!

Taking Charge of our own Health

As a nation, we spend a LOT of money on health care. It’s expensive for a couple of reasons: the amazing discoveries, technologies and research which allow for astonishing cures and healing of human suffering is expensive to create. And secondly, because we Americans have treated health care not as a right, like public education, but as a service that we purchase, like energy or food.

Because of the early national decision to treat health care as a service, the pace and cost of advances in medicine has out-stripped most Americans’ ability to pay for it themselves. Hence, the explosion in the last century of our dependence on health insurance. We have become so dependent upon it as an addition to our pay, most of us have come to think of health care as something that our insurance pays for, as if it were an additional source of revenue to our family instead of a support to the health care we purchase.

This model leaves the poor, homeless and unemployed dependent upon our hospitals’ emergency system to receive the health care they need. And because treating normal health issues in the ER is like sending a battle ship to take you fishing, this solution is not much of one. But we are so wedded to the health care as a service model, the only solution that the best minds of our day can come up with is to provide universal health care coverage.

What makes me a bit crazy about this solution is the increased dependence we all have on insurance companies. And with this increase in dependence, comes a pressure to keep costs down as they add members who may use more insurance on average than others. So while more of us are covered, the coverage shrinks in response.

While this may be good for most Americans, it has not been good at all for mental health providers. We are the lowest paid health care providers as a group in the country, and reimbursements for our work are getting smaller and smaller each year. More of us are leaving our contracts with the large insurers, and some of us begin our private practices without signing contracts at all, focusing on serving the most people we can as Out-of-Network, or non-preferred professionals.

Mental health, one of the most important of the healing arts to learn and master, is slowly being pushed out of the health care arena. If you have tried to get an appointment with a local psychiatrist lately, you will know exactly this first hand. The recession has made this shortage worse, as the larger health systems cut back on mental health clinics and out-patient therapists.

While we continue to try to solve this growing crisis, we each need to consider how important our health is to us and act proactively. We need to stop expecting doctors to fix things after we have done willing damage to ourselves either by inactivity, abuse of alcohol, food, drugs or other things we ingest. We need to limit the excesses we have come to demand of medicine, whether that be for antibiotics, plastic surgery or that third or fourth expensive test. And we need to put our money where our personal priorities are, and be willing to pay a larger portion of our own care in our daily budget.

We have grown fat, literally and figuratively, at the table of insurers. We are bloated by the expectations that medicine, physical and mental health care are paid by someone else. If it is essential to our lives, we need to add it into our budgets, just like we do when we put gas in our cars and and food on our tables. Like it or not, we buy the things we need in our economy, and we must grow to understand that all this health care is not someone else’s bill, but our own.

“In insurance we trust” could be the motto of many Americans. As more of us receive coverage, more of our income will need to be set aside for health coverage. And that is as is should be, if only so long as we commonly consider health care a service we pay for, and for which we should have choices as consumers. 

Parenting is Still an Artform

As the summer ticks away, I am spending a lot of time with and for my teenagers. It has me thinking about this generation of youth, how they have been parented, and how many have bemoaned their development. I’ve written about it in my latest GoodTherapy.org blog posting. I hope you’ll visit it there, comment, and let me know how you feel about the children of the Baby Boomers.

Parenting is Still an Artform

Are You Kidding?

The Vatican has just issued a new ruling that equates ordaining women to the sin of pedophilia.

How any person of Christian faith and vision can think and write this theological argument takes my breath away. While the leadership of the Roman Catholic Church is blindly adhering to their reactionary 17th Century theology and practice, the people of the contemporary American Roman Catholic community reel from the growing child abuse scandal that threatens to bankrupt every diocese and struggle with a severe and unending shortage of parish priests. Their leaders are making decisions and issuing decisions that should anger every believing Catholic. But where is the local protest?

Unlike a generation or two ago, the protest is out the door, beyond the parking lot and in the hearts and minds of the disaffected Catholic community. While many believing Catholics are struggling to do ministry, love God and neighbor, worship and educate their children in the faith, others have left the community and not looked back.

I believe that the small revisionist groups that have sprung up in and around the American RC community will, within another generation, cause a full split from the Roman leadership and create their own church. Or, at least they should. It’s time for a new Catholic reformation in America before there is no church left to reform.

New York Times article, 7.15.2010

Summertime Unease

The summer is a difficult time to be a church-attending believer.

The pews empty, what with church education programs closed down for summer break, clergy finally taking some long-anticipated vacation time, choirs enjoying their evenings free of rehearsals and every other family traveling somewhere. Some congregations do better than others, having a longer visiting clergy list to draw from, or a deep bench of talented musicians to call on to carry the songs and liturgies along.  But the offering plates are dangerously lean, and the newsletter articles about the summer mission trips are anxious and urgent in their optimism. In those congregations where there is literally nothing between services, the hours pastors walk the halls of an empty building during a 3 service Sunday is deadening to their spirit, believe me. The church seems more dying than asleep.

The only up sides I enjoy in summer church are easier parking and longer Sundays at home. Not good indicators of a strong communal future.

I have never felt the demise of the traditional Protestant parish to be so urgent as I have in the last two years. I’m sure my late optimism was driven into me, having graduated from a traditional Midwest Lutheran seminary full of teachers and administrators educated and serving in the heyday of the institutional Church, the 1950s and ’60’s.  A changing American church? They didn’t see it coming. Or if they did, they looked the other way. Ordained in 1984, I remember all the years of denominational articles, letters, programs, trainings and trips to stimulate the parish life I inherited. I knew I was captain to a ship taking on water. Members expected strength, growth and spiritual pride in their church. I bailed faster, and felt the panic deep within me. Some of that panic propelled me out of parish ministry in 2004. In the six years since, I’ve been quite focused on my training and work of family therapy. But I haven’t left.

I struggle with this common distraction and panic. Everywhere I turn, the denomination I claim as my own seems lost in a scramble for relevance. Liturgy, once rich with words and movements and rhythm has been replaced by giant screens flashing PowerPoint versions of reworded creeds. I am numbed and bored, and I don’t seem to have a place any more. The denomination I claim to be my second church home keeps moving along with a common liturgical focus and broad social net, but seems nonplussed by its lack of growth and aging congregants.

There is a new time of the Church coming, but I can’t see around the corner just yet. I’ve been reading the New Testament book of The Acts of the Apostles in the one hand, and Phyllis Tickle’s 2008 The Great Emergence: How Christianity is Changing and Why in the other.  This summer, with empty pews and open parking lots, the questions seem particularly urgent.