Psychologists and other mental health professionals talk a lot about labels. There are reasons, of course: We all know what it means when someone is depressed, for example. We can understand it as a state of mind aside from it being a diagnostic label. We know that if someone is schizophrenic, it is a very sad situation. Labels exist so people can communicate without needing a long explanation each time. I get that, of course. In my profession, we also say that to provide the right treatment, we need the right diagnosis; while there is leeway in the treatments that may be provided, there is truth also in the belief that the right diagnosis shapes the treatment options we consider. To continue with the same example, you would not treat someone depressed in the same way you would someone with a psychosis; however, I would hope that many things would be the same—the caring, the respect, and the remembering that both are human beings with feelings. It is this last point that I have been thinking about for a long time—for years really.
Parents are the major influence on the self-esteem of their children, and yet sometimes get so wrapped up in wanting them to do well or to be the “best” at something, they forget the effect they are having. I think it is helpful to look at what not to do. When my daughter was five and a half, we adopted her from South America. She went to preschool for a time and then Kindergarten. I speak Spanish but she learned English very quickly.
When she was in Kindergarten, she took a standardized test and scored in the 97th percentile in language skills. When I picked her up from school and we were walking to the car, I said it was amazing that she did so well, especially as she was still learning English. We got to the car, and seconds afterwards a classmate and his mother were getting to their car. The mother was screaming at this child, whom I will call Chuck. She yelled, “You just did AVERAGE! AVERAGE! How do you think that makes me feel?” and she went on to berate him as he got into the car with his head down. I didn’t say anything to her, because this kind of emotional abuse is not illegal and I feared making things worse for the little boy. My daughter said to me, “I guess Chuck’s mom isn’t so happy with him.” She asked me why the mother was so angry, and I tried my best to answer her.
She was about 80 and didn't consider herself old. She lived in a nursing home with her husband, who usually didn't know who she was. She couldn't hear, so doing therapy with her meant you had to write her notes, and very quickly. She was also extremely intelligent, probably gifted, but then in her era most people didn't care if a woman was gifted, and she was pushed to get married and have children. She got dialysis a few times a week, and I hadn't known how brutal a process this is, involving sitting up for hours and having huge bruises to show for it. She had one leg as her diabetes necessitated an amputation.
I never knew anyone as grateful for life as she was. She once told me that she knew I would cry for her when she died, but that she would be living in glory, happy as can be in a better place. Yet she was human. A doctor once talked down to her and she was understandably very angry. She was very religious and said that people with their egos made her sick. In mid-session she started to laugh and said, "Look at me! I'm not much better than he is or I wouldn't be so upset!" We talked about how it is easier to not involve the ego so much when not challenged by someone who is really stuck there and how quickly we can fall. She often said she loved me, and told me I was not a pompous ass. I would tell her sometimes in my field you end up being therapist to someone superior to you and you keep learning from them. She smiled.
A lot of well-meaning people often say to psychologists that we deal with “depressing things” and are always concerned with emotional pain. A lot of people think that talking or writing about painful topics is somehow “negative,” and I would like to address this issue, as well as the “upbeat” part of the psychotherapist’s work.
In all fairness, anyone concerned with healing is concerned with the disease process in the physical realm, and emotional pain in the psychological. (This article does not address the mind-body-spirit connection, which is also very important.) It is very hard to change or to facilitate the healing process without addressing the issues. As a professor of mine once said, “No one goes to a psychologist to say that life has been great, or because they just wanted to be nice to psychologists.” This is true. People come in because they are experiencing pretty extreme emotional unease. Those who have had therapy come in recognizing that they have done some of the work and want to do more.
One of the painful things about being a psychotherapist is sometimes seeing problems as they are developing in children, and being unable to change the circumstances that foster these problems. In the past I did many psychological evaluations of children, and would sometimes see them periodically over the course of years. There is certainly much mistreatment of children that never reaches the attention of the authorities, but evaluating these children, who were in foster care year after year, taught me a lot about our system and about the human condition. I remembered again some of these children as I wrote my book, and was thinking recently about how many of the issues I often see now in my adult clients, like obsessive-compulsive disorder, were born during childhoods not so different from those of the children I used to see. I'd like to tell you about "Elena," one of the children I evaluated, to illustrate how our experiences as children mold and shape our personalities.
Elena was four years old when I first saw her. She was physically and sexually abused by one of her mother’s boyfriends, and her mother said she did not believe her. When Elena began to act out with others, the authorities became involved. Her mother belittled her often, and did it in front of others. The current boyfriend cursed at her, called her names, and would go into alcoholic rages that were unpredictable. He had been physically abusive, but when he began to sexually abuse her Elena became even more frightened all the time. She remained at home for several years while services were provided to the mother and the boyfriend moved out, but there were other boyfriends and she was often left alone in the house, without food or support of any kind. Elena had therapy, but the result was minimal as her mother was uncooperative. When Elena would cry or tell her mother she was afraid of the dark and afraid to be in her room, her mother would laugh and make fun of her.
Aleta Edwards, Psy.D.
I am a psychotherapist in private practice, with a strong interest in shame and perfectionism. I will periodically post my thoughts about these topics and other observations relating to emotional health.