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When Children Have a Chronic Illness

Children with chronic illness Chronic illness may have devastating effects not only on a child's physical development but also on a child's psychological development.

Ill children are often treated differently by their peers who see them as dissimilar and fragile.  Frequent absences from school can prevent a child from forming strong relationships and being an integral part of the school community. 

A chronically ill child is treated differently in the family, too.  Some parents may overindulge their sickly child trying to overcompensate for the unjust hardships and deprivation the child may face.  Parents may be understandably overprotective and unnecessarily shield the child from every challenge.  Puberty is a particularly difficult time.  It is the time when the child strives for independence and detachment from the family, but for a child with chronic illness that leap towards independence is often thwarted by the dependence on others that is necessasary because of the chronic illness.

There are also effects on other family members.  Parents can become overwhelmed by and resentful of the enormous demands their child's illness causes.  Siblings may be resentful because the sick child requires more time and care, invariably taking time and care away from them.  When family members feel angry and resentful while at the same time feeling guilty about their misplaced and inappropriate emotions, there is conflict.  These conflicting feelings are communicated to the ill child and influence the ill child's sense of self.

Children with or without chronic illness learn who they are from their parents and others closest to them.  Loved children feel lovable; abused children often believe they are bad and deserving of abuse; and children of depressed parents often feel inadequate because they fail to make a parent happy. 

Family therapy might be very useful in helping the family of a child with a chronic illness to develop  well, without maladaptive character traits or, worse, a character disorder.  Once that happens, treatment is much more difficult.

I'm Dr. Blokar.  For more information, click on the following resources: 

Helping Children and Adolescents with Chronic and Serious Medical Conditions:A Strengths-Based Approach 

Extreme Parenting:Parenting Your Child with A Chronic Illness 

Parenting Children with Health Issues 

Families Living with Chronic Illness and Disability:Interventions,Challenges, and Opportunities 

In Sickness and in Play:Children Coping with Chronic Illness  


Casey Johnson and Juvenile Diabetes

Casey johnson dies Casey Johnson, heir to the Johnson & Johnson fortune, died recently at the age of 30.  Now, snippets of her life that we are hearing about and seeing reveal that like many other children of the rich and famous, her life was a shipwreck.  Someone should do a study on why people who have so much going for them, so much of what all the rest of us want, either get into trouble and end up having to throw it all away, or die young without ever really enjoying what they had.

Casey Johnson, though, had something else besides wealth and privilege.  As a very young girl she was diagnosed with juvenile diabetes, an incurable disease that takes constant management.  Imagine her having to go through daily finger prickings in order to monitor her blood sugar level.  And imagine having to think about everything you eat in order to keep your blood sugar numbers at an acceptable level.  And think about having to restrict physical activity because overexertion can reduce one's blood sugar numbers to dangerously low levels.  And, of course, there are the daily injections of insulin to control symptoms.

Some of those symptoms, like fainting or becoming incoherent, can result in emergency trips to the hospital, often being witnessed by peers which can be embarrassing.  The growing up process unfolds in a field full of potential land mines.  Puberty is a particularly disruptive and challenging time for kids with diabetes.  The struggle between childhood and emerging adulthood, when the young person wants to assert him/herself, break away from family and shift one's loyalty to one's peers, can be particularly difficult because the chronic illness requires ongoing adult supervision.  In addition, being different and sick can be embarrassing.  Many young diabetics rebel against their illness by challenging it with careless abandon, resulting in more hospitalizations and more embarrassment. 

No doubt, Casey Johnson's diabetes, as well as her wealth and name, shaped her personality.  And there is some sad irony, and maybe subliminal anger in Casey, that the company that gave her such wealth by creating medications to treat so many illnesses never created one that could cure her diabetes. 

But at age 30, when asked what her biggest regret was, Casey Johnson did not say "having diabetes."  She said it was not doing the reality television show with her friend  Paris Hilton. 

I'm Dr. Blokar.  For more information, click on the following resources:

Type 1 Diabetes for Dummies

The Everything Parent's Guide to Children with Juvenile Diabetes

Type 1 Diabetes:A Guide for Children, Adolescents,Young Adults--and Their Caregivers, Third Edition 

Taking Diabetes to School 

487 Really Cool Tips for Kids with Diabetes  


Multiple Personality Disorder (Dissociative Identity Disorder)

The-Three-Faces-of-Eve  Popularized years ago in the movie "The Three Faces of Eve," Multiple Personality Disorder (now known as Dissociative Identity Disorder) was recently back in the news.  A New York man who murdered his family claims he suffers from this ailment and that one of his other personalities committed the crime.

According to the Diagnostic and Statistical Manual of Mental Disorders, the main feature of this disorder is "the presence of two or more distinct identities or personality states."   The disorder is more prevalent in women than in men with the ratio often stated as 9 to 1 female to male.  People with this disorder test high in their  hypnotizability. Although the disorder tends to be chronic and recurring, it is less manifest beyond the late forties but can reemerge with trauma or alcohol or drug abuse; drugs and alcohol lower the defenses and barriers that the dominant personality has built. 

The dominant personality carries the person's given name and is passive, dependent, guilt-ridden and depressed.  The other personalities may have different names, different memories, and a different vocabulary and level of knowledge.  These personalities may deny knowledge of one another, may be critical of  each other or may even be in open conflict.

The alternate personalities are usually quite different from the dominant personality.  They are often aggressive, provocative and hostile. Their memories are often more complete than those of the dominant personality, which makes sense since the disorder usually develops from severe trauma, such as physical or sexual abuse that took place in the dominant personality's childhood.

The dominant personality developed survival strategies by becoming less visible and by burying her memories deep into her subconscious.  The trauma that the dominant personality was exposed to and which she pushes away and tries to forget reemerges in alternate personalities who dare to remember, even remembering the original trauma to which the dominant personality was exposed.  The alternate personalities may be highly critical of the dominant personality's squeamish, mousy and passive ways.

The dominant personality, on the other hand, is not aware of the other personalities which sometimes can take years to discover.  People around the dominant personality may keep telling her that she behaved in an inappropriate way, atypical of her usual behavior and about which she has no recall.  The dominant personality may sometimes find pieces of provocative clothing that she not only cannot remember buying, but also says she would not be caught "dead" wearing!

Diagnosing this disorder seems to be on the rise.  In my opinion, it has been over-diagnosed.  It seems to me that many patients suffering from borderline personality disorder who are by nature highly suggestible and hypnotizable and whose personalities are ill-defined and fluid and who often abuse alcohol and drugs, may be coached by a therapist hunting for an exotic disease into believing they have multiple personality disorder. 

I'm Dr. Blokar.  For more information, click on the following resources:

Dissociative Identity Disorder:Diagnosis,Clinical Features, and Treatment of Multiple Personality

Jekyll on Trial:Multiple Personality Disorder and Criminal Law 

Breaking Free:My Life With Dissociative Identity Disorder  

Switching Time:A Doctor's Harrowing Story of Treating a Woman with 17 Personalities 

Bluebird:Deliberate Creation of Multiple Personality by Psychiatrists 

The Bifurcation of the Self:The History and Theory of Dissociation and Its Disorders 

Hoax and Reality:the Bizarre World of Multiple Personality Disorder 

The Dissociative Identity Disorder Sourcebook 

Mistakes Were Made (But Not By Me)  


What Causes The Holiday Blues and Can They Be Avoided?

Satisfied%20guests  In Western countries, the suicide rate is highest during this holiday season.  The reasons for this are many and complex.  The expectation of the season, which has lost a good part of its spiritual and religious meanings, is to have a jolly good time, but good times do not necessarily follow a predetermined time frame; they come and go regardless of our expectations.  And all the merry making around us when we feel blue just makes us feel worse.

The holiday season practically forces us to take note of our achievements and failures, including last year's resolutions which mostly went unfulfilled, just like the resolutions of the year before that.  It is hard to face the fact that we were not able to live up to the promises we made to ourselves and to others.

This is also the season of voracious consumerism. No matter how much we buy, instead of feeling fulfilled we feel emptiness and a growing longing for more things.  We may even feel sadness that we can't afford what we want and jealousy of those who have and can afford more.

In addition, the pressure of gift giving can add to our holiday sadness.  Some of us feel we must give the perfect gift, sometimes within a strict budget.  And even if cost is not a factor, it is hard to come up with that special meaningful present for everyone who needs to be gifted.

Going home for the holidays is suppossed to be joyful, warm, fulfilling and serene.  In too many families, though, the modus operandi is anything but.  One tends to regress in emotionally charged situations, so many of us respond as we did as children when parents and relatives push certain buttons.   But you are an adult now, and this is your life, so take possession of it and be proud.

Learn not to apologize or feel ashamed for your failures.  And don't feel you have to perform spectacularly.  Your best approach is to dare to be yourself.   Be tolerant of others for they, too, have their own struggles.

The expectations we put on ourselves, our families and our close friends this season are so high and the pressure is so great that it ultimately proves to be too much to bear.  A cetain amount of letdown is unavoidable.  Family gatherings, however, are not the place for dramatic and forced resolutions of the family dynamics.  Individual and group therapy, if warranted, is a much better place for venting your regrets and casting the blame.  The ensuing results are beneficial and lasting.

I'm Dr. Blokar.  For more information, click on the following resources: 

The Family Gathering Survival Plan

Happy Holidays:How to Beat the Holiday Blues 

Holiday Blues Rediscovering the Art of Celebration 

No More Holiday Blues:Uplifting Advice for Recapturing the True Spirit of Christmas, Hanukkah, and the New Year  


Promiscuity and Young People

Promiscuous140806_228x357  When young people are promiscuous, there are consequences.  Young men are hot, in their sexual prime with raging hormones.  They are too often ready for sexual encounters, and these days there is no shortage of willing participants.  As a result, even in the best colleges, a very high percentage of 18-22 year olds test positive for human papilloma virus (HPV). For women, the consequences of HPV can be severe, varying from the inability to become pregnant later to developing cervical cancer.  Although there is a new new vaccine designed to prevent HPV, it is not 100% effective, and there are reports of severe illness occurring in some people after receiving the vaccination.

Why, then, do most girls -- especially those who believe they are in a monogomous relationship -- not insist that their partner use condoms?  Perhaps it is because women tend to project onto men their own way of looking at things and their own values.  Young women often believe what they want to believe, in spite of evidence to the contrary.  And women's desire to please, and their submissive nature, are also factors.  

Women do not realize that originally men were not made to be faithful, because men's progeny had the best chance of survival if their sperm was spread far and wide.  The fact that our culture now has different  requirments and values has not changed men's original genetic imprint.  Unfortunately, therefore, young men, when mature enough and ready to love and cherish one woman, will pass on to her the unwanted consequences of their promiscuous youth.

We like to insist that men and women are the same, but insisting does not make it true.  We are very different indeed, and yet there is beauty and challenge and potential for growth in our meetiing and coming together. 

I'm Dr. Blokar.  For more information, click on the following resources:

Laid:Young People's Experiences With Sex in an Easy-Access Culture 

Promiscuous Teen:Cause for Concern 

Sex and the Soul of a Woman:The Reality of Love & Romance in an Age of Casual Sex  


Alzheimer's:Blessing in Disguise?

Dr. E (Ph.D.) Speaks Out:Guest Blogger

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While watching Sargent Shriver, who has Alzheimer's Disease, wave goodbye at his wife's (Eunice Kennedy Shriver) funeral several weeks ago, and having recently placed a relative with age-related memory loss in a long term care facility,  I had some thoughts. 

Of course, every Baby Boomer in America wants there to be a prevention and cure ASAP for Alzheimer's and other age-related dementias and memory loss conditions, and that would be great, no doubt about it!  But if not, could it be that these conditions are Nature's way of helping us face old age and death?   Might Alzheimer's be a blessing in disguise?

For elderly people with Alzheimer's, they may not know what or who they don't remember, so maybe their condition is not upsetting to them.  Perhaps Sargent Shriver was told he was there to say goodbye to his wife, but since he may not remember her or their long life together, he did what a child does when told to say goodbye.  He smiled and waved, like a child at a parade as people march by, rather than feel the unbearable pain of his terrible loss. 

And since elderly people with Alzheimer's may not remember they are old or perhaps even know any longer what death is, how can they be depressed about it or fear it?   Ignorance is bliss, in a way, isn't it?

It is hard on family and friends who miss the person who used to be, for sure, and who fear ever being like the person with memory loss.  But maybe the fear is not necessary.

Now, mind you, I am talking about these dementias in only elderly people, not early onset memory loss, which is a real tragedy with no upside at all.  But otherwise, let's work towards prevention and a cure, but not worry too much if that doesn't happen.  And if there is a prevention and cure, we will have to find another way besides Alzheimer's to cope with old age and death.

I'm Dr. E., Guest Blogger.

For more on the subject, check out the following:

Alzheimer's From the Inside Out

The Myth of Alzheimer's:What You Aren't Being Told About Today's Most Dreaded Diagnosis 

Alzheimer's:A Caretaker's Journal

Alzheimer's Disease and Other Dementias:A Practical Guide  


What Was David Letterman Thinking!

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Talk show host, David Letterman, a high-profile person, after being threatened with blackmail admitted to having numerous sexual liaisons with women who work for him.  Whether he was legally married at the time we do not know, but he was certainly in a long-term relationship with the woman to whom he is now married and with whom he has a 6-year-old son.

One would think that men, especially successful ones, would be more diligent about controlling their libido, but men's appetite for exciting, new, extramarital sex will not abate.  When Bill Clinton was asked why he got involved with Monica Lewinsky, he stated simply, "Because I could."  His and Letterman's success and power, and that of men like them, attract ambitious women who can bask in the men's power, can be wined and dined, mentored and promoted.

Young, single women and powerful married men usually deserve one another.  Problems arise when one of them feels she/he didn't get what they bargained for, and the games involving body and greed may lead to a broken heart or wounded pride.

Then things can turn ugly -- going public, blackmail, extortion, or even violence.  And do not forget potential problems at home -- a vengeful spouse, depressed children, an expensive/acrimonious  divorce, and loss of job, property and finances.   Overall, a nasty disruption in life's routine -- from easy coasting along in the pleasant waters of privilege and indiscretions to catastrophe.

This may be the price one pays for playing with fire.  Was it worth it for Letterman and other men like him?  

I'm Dr. Blokar.  For more on this, click on the following resources:

Intimacy:An International Survey of the Sex Lives of People at Work

9-5 Sex, Lust,Lives Destroyed:What Happens When Sex Blossoms in the Workplace 

Dirty Little Secrets:Sex and the Workplace 

Sex and Business:Ethics of Sexuality in Business and the Workplace 

Sex at Work:Attraction,Harassment,Flirtation and Discrimination  


The Future for Jaycee Dugard and Her Daughters

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People are wondering what the future holds for Jaycee Dugard, kidnapped by a stranger and held captive for 18 years, and her two children (fathered by her captor).  We have very few examples from which we have learned enough to make a fully informed prediction.

What we do know is that sexually abused children are damaged, and they usually show it.  They are withdrawn, preoccupied, depressed, perform poorly in school and have few friends.  First hand reports from people who knew Jaycee and her children, and from an aunt with whom she has recently been reunited, however, did not and do not now see these symptoms in Jaycee or her children.  Perhaps, having been raised until she was 11 by a loving mother and stepfather, Jaycee already had developed a solid core when she was kidnapped.  At 11, she was still a pliable child but she was able to distinguish real from unreal.  And, the perpetrator does not seem to have severely beaten her or her children over the years. 

In medical school years ago, students were taught that the brain was fully developed by age 5.  Now we know that we develop the ability to think abstractly at around age 13, and that there is a surge of brain growth in adolescence.  At the same time, the areas of the brain that are crucial for the formation of successful interpersonal relationships and problem solving are also rapidly developing.  Severe and complex traumatic events, abuse, and severe neglect may result in an inability to regulate emotions, in errratic and unpredictable behaviors, in impaired cognition and even in an inability to form a solid identity.

Jaycee, and especially her children, who were never socialized, may suffer from these deficiencies.  We do no know how much can be repaired or at least patched up enough so that they do not spend the rest of their lives in the throes of ever present anxiety and despair.

I'm Dr. Blokar. 

To learn more about stages of child development, click  on the following:

Child Development and Education

Your Child's Growing Mind:Brain Development and Learning From Birth To Adolescence 

Observing and Understanding Child Development

Guiding Children's Social Development and Learning  


Jaycee Dugard and the Stockholm Syndrome

Dugard

In the news is another heart-breaking story.  A girl, now a woman, abducted 18 years ago when she was 11, was found alive with two children, ages 11 and 15, in the backyard of her captors' home.  One of the first questions in many people's minds is why didn't she try to escape from her hiding place which did not appear too difficult to run from.

One reason is that since she was only 11 when she was kidnapped, she was still a child unable to think in abstract terms, and the ability to think in abstract terms is important.  It is a uniquely human ability that enables us to see similarities and parrallels in otherwise unrelated objects and events.  It enables us to incorporate principles of common knowledge and to predict outcomes. 

Another possible factor might have been her relationship or lack of relationship with her biological father.  It appears that her stepfather cares for her deeply, but we have heard nothing about her biological father.  Her relationship with her biological father may have further complicated her confusion about her male captor, yet another man in her life.

One fact is certain: Jaycee definitely wanted to survive.  At 11 she was too afraid and too helpless to flee.  By the time she 13 she was pregnant, and by 14 she had a child.  By that time, the relationships in that household were too intimate and entrenched.  For her to survive initially, and then for her to protect her children, she had to succumb to her captors' will.  Her existence would have been unbearable if she were not able to embrace some aspsect of her life with her kidnappers.  That is known as the Stockholm Syndrome, and it is real.

I'm Dr. Blokar.

For more information about this topic, click on the following books:

Child Abduction:Prevention, Investigation and Recovery

Invisible Chains  


Civility in the Subway:Both Gratifying and Depressing

Dr. E (Ph.D.) Speaks Out: Guest Blogger

NYCSub_7_car_exterior The other day while my husband and I were seated on a bus going down Fifth Avenue in New York City, an elderly man and woman got on together.  Although we are seniors, the couple looked much older than us, so we offered them our seats.  While the husband seemed to want to sit very badly, his wife declined and continued to struggle holding on.  Since a gentleman from "the old days" would never sit while the woman he was with was standing, he suffered, longingly looking at any seat that became available.

The next day my husband and I were on a crowded subway on our way to Times Square in New York City.  We stood holding on to a pole along with many other riders.  In a matter of minutes, several people offered us seats.  And we graciously declined.

Suddenly, we understood the woman on the bus the day before.   While we were very gratified by everyone's generosity in offering us a seat, and happy to know that civility is alive and well in New York City, we also felt a little depressed.

As I said with a smile to one of the nice young women who offered a seat, "We must look very old today."  

"Not at all," she replied with a little laugh, probably thinking that maybe next time she should not offer a seat.

Better to offer the seat and let the "senior in denial" politely decline than not to offer the seat at all.

I'm Dr. E, Guest Blogger.

For more on the subject, check out the following:

Choosing Civility:The Twenty-Five Rules of Considerate Conduct

Aging with Grace 

The Beauty of Aging:Growing Older With Grace,Gratitude and Grit