Getting to Yes

Last night, T came to ask permission to go to the movies with his girlfriend tomorrow. A perfectly mundane occurrence in some households, but kind of extraordinary in ours. A constant refrain in our house is "Come with a plan, and ask for what you want in a straightforward way." He started strong, great eye contact, a nice smile, a perfectly reasonable request ("I'd like to go to the movies tomorrow"). But he lost confidence half way through and started to interrogate me so as to try to trap me into saying yes. I stopped him and said, "It's been a good week - why don't you just ask for what you want and see what I say?" To this, he blurted out "I'm afraid because you might say no!"

I imagine that we all feel that way when we make ourselves vulnerable by exposing a desire and giving another person the power to grant it or not. But the fear is really exaggerated in T, as it must be in other kids who've been severely abused from a young age. At a time when he was meant to be voicing his needs without forethought, he was in a situation where even the most basic childish desire would likely be ignored, or lead to punishment, suffering, shame and humiliation. To ask to have his needs or wants met was an extremely risky proposition.

For three years, we have been working with him on asking for what he wants with confidence. In our early days together, he couldn't ask for anything at all - he found it quite difficult to allow himself to want anything in the first place, much less ask for it. We had to start with the basics - eye contact and putting things into words. We would often structure multiple options and ask him to choose, working on identifying simple preferences, as the first step to voicing requests.

As he emerged from his shell and started to have specific desires - a new pair of jeans, a night out with friends - he was like a man who awakens to his last night on earth. The wanting ran wild. He had no sense of "normal". He was so hungry for experiences, and so accustomed to loss, he would go nuts with the exhilaration of the moment. He still does that sometimes, exacerbated by substance abuse - containing himself for days on end, then wheedling/manipulating/threatening/sneaking what he wants. Then he's struck by guilt, remorse and consequences and sequesters himself again. Finding balance will be a lifelong project.

There have been many "no"s in our house lately, as he was in a relapse. We decided to restrict a great many things in order to communicate that we would not participate in or tacitly support his relapse behavior. It's a joy to all of us that he has pulled himself out of the relapse with a great deal of hard work (he voluntarily entered an outpatient substance abuse program where he goes for four hours, three times a week). So it was a joy to give him a "yes" last night.

Getting in trouble or being denied is what he expects and confirms his belief that he's a bad kid. And by the same token, making a reasonable request and hearing "yes" is so abnormal in his experience that he doesn't even know what such a conversation might sound like. He is unaccustomed to being treated like a reasonable and deserving person, and to thinking of himself that way.

He got his "yes". He deserved it, too.

Patient

This year, I had (technically, still have) thyroid cancer, which is my first significant medical event, pretty much ever. Through that experience, I learned firsthand what it means to be a patient manifesting a disease that is still somewhat mysterious to the medical field. Navigating treatment means consulting with a team of doctors who have different components of knowledge, approaches to treatment, and theories of the disease. In the course of such treatment, I was surprised to learn, it is the patient's job to make the call - to decide to pursue this treatment or that one, to go with this doctor or that one, and to rest content with this test result, or press for another. It was more than I could assimilate on my own, and I needed my partner to help me evaluate information and exercise my judgment about treatment.

That is very much what it's like to seek help for a kid like T. Just as thyroid cancer is fairly rare, a childhood marked by the type of developmental adversity that he faced is unusual. Even within the world of older child foster/adoption, he is unusual - his adoption social worker told me that she found his case shocking. Treatment providers too have rarely seen such a combination of prenatal drug exposure, early infant adversity, long-term abuse, attachment disruptions, and physical/brain trauma - and all this combined with native intelligence, charisma, and sophisticated survival strategies. Of course, they also rarely see an adolescent who voluntarily sought adoption and is attaching to new parents in the midst of all this, a fact that introduces a host of adjustment issues of its own.

For all of these reasons, getting what he needs in terms of mental health care is a complex enterprise involving an evolving small team of providers (two to three at a time). They typically have different methodologies and perspectives, and arriving at a plan requires a fair amount of guess work and a lot of decision-making.

Being his parent therefore means being his medical advocate, among other things. I'm sure that's true of all adoptive parents of distressed, traumatized kids. As we seek to be effective in that role, it has come to me that the recipe for effective parenting looks something like this:

- a huge amount of patience
- acceptance that progress may be partial and temporary
- balance between holding him accountable and recognizing that he has limitations beyond his control
- a flexible and relative set of expectations, particularly around what constitutes a good life
- a willingness to defer to experts with superior knowledge, combined with reasonable skepticism about any one approach
- a thick skin while interacting with professionals who may question one's parenting or assert an approach that you know just isn't going to be effective at home
- love and a depth of understanding the full personality of the child so as to avoid ever reducing him or her to the sum of their disabilities and struggles
- a gut sense of when to "turn it off" and take him shopping for shoes or let him go to a friend's house to give him a break and let him just be a kid

Adolescence is tough for any kid, but it's pretty obvious that it's a whole other level of challenge for kids like mine. I used to tip toe around discussing these disorders with or in front of T, for fear of hurting him. I've learned that I needn't do that - he knows he's hurt and he wants help. He may put up a defensive attitude, but he shows up for every appointment, he lets me speak frankly about the patterns we see at home, he takes his medicine, and he is not reluctant to acknowledge that he's different.

In turn, I make a point of casting things in a positive light by letting him know that we speak frankly about his behavior not to shame him but to help him; we are looking for patterns so that he has information he can share with his doctors as he moves forward into adulthood, and so he can understand himself as much as possible.

At home, our growing awareness of his challenges have informed our approach to discipline for sure. He's nearly 18 now and we've been with him since he was 15. Over time, we've realized that he benefits from restrictions on his privileges and independence in ways that may seem unusual given his age and intelligence. We restrict things these days - driving, cell phones - because his compromised ability to control his impulses and exercise forethought and judgment mean that such things can be like giving adult scissors to a toddler.

Earlier in our parenting adventure, we tried using such privileges as incentives. Frankly, that doesn't work for us at all. Incentives don't work if the child is not capable yet of doing what you're asking him to. We can say to him "It's not safe or smart for us to give you a cell phone right now. Let's focus on the goals we've set, and we'll talk about the cell phone later." The other response that works is "Let's focus on your goal of finding and succeeding in a job, and then you'll be able to buy yourself a cell phone." What doesn't work is "When you do (x), then we'll give you a phone."

I am struck over and over in parenting him how much we (parents, teachers, administrators, employers) are all steeped in the expectation that behavior is the result of appropriate discipline made up of incentives and rewards. That presumes a fairly linear and deliberate mental path, and kids like T take weird unconscious detours all the time. There are unusual factors involving organic brain development, neurological pathways, biochemical mood regulators, and all sorts of other things that confound simple disciplinary techniques. He deserves to feel loved and encouraged to be successful within his realm of possibility, not just disciplined and corrected. And defining his realm of possibility is an ever evolving, expanding work in progress that benefits from feedback from his mental health providers, but also from the support of a parent advocate.

I'm not a perfect parent advocate, and some days I'm not even particularly good. But I do feel strongly that all kids like T need someone in that role, and that we should prepare such parents to exercise a different approach than conventional parenting.

Christmas Wishes

I just read a story about a naked man who bolted from the back of an ambulance and was run over on the freeway today. The news presented it as a bizarre tidbit, but I understood immediately what must have happened. I've been thinking a lot this week about compassionate care for people suffering from mental illness.

This Christmas, T is in relapse, and just went through what his doctor describes as an extended hypomanic cycle. We have to withhold the new cell phone we intended for Santa to deliver, along with any other present he might sell or misuse. Meanwhile, his brother, who was to spend Christmas with us, is locked up in juvenile hall. He's only 14, and he'll wait in juvenile hall indefinitely while his social worker figures out where to put him next. It will be his fourth placement in three months.

Both boys suffer from different types of mental illness and disability. T is extremely bright, and apparently high achieving, handsome and capable of great compassion. His demons are more hidden, and his impairment manifests in extreme mood swings, grandiosity tempered with insecurity, periods of excessive self-discipline alternating with bursts of wild abandon. When he learned about his brother today, he drew his lips tight over his teeth as if to contain all the feeling - the shock, the guilt, the shame, the fear that have all been with him since he was about six. Eleven years is a long time for a child to carry such a painful bubble of mixed emotion.

I can write about him with compassion, but in the day to day as a parent, I'm exceedingly aware of my limitations. I get angry with T's behavior, and with him. I try to discipline, negotiate, incentivize, and wheedle him into changing. I work daily to manage my tendency to enable him. I recognize that sometimes a parent is the last person likely to help a kid in distress - a counselor, nurse, doctor, a coach, but some days, not me. My maternal love for him is a blessing and a blind spot. I truly struggle with the boundary between holding him accountable for his behavior and recognizing that self-governance is, at times, beyond his capacity.

The literature about enabling, codependence, and compassionate discipline is helpful, to a degree, but I find that it has the unintended side effect of making it seem that there are answers. When we are in a rough period, as we are now, I've learned there truly are no answers. It's more like meditation - the best I can do if I really try is to remain objectively aware of what is really going on, and to cease trying to control it.

Even when T is at his worst, the one thing he responds to is honesty. This week he said softly, "You must be worried." I said, "Yeah, it's really hard when you love your kid so much, and they're on a path that harms them, and you know you can't convince them to get off that path. And you see all the things that make it so hard for them. And you try to support them. But you also have to make sure you don't do anything or give them anything that might contribute to your kid making those bad choices. It's hard to say no to your child, but you know you have to, because you love them, even when it makes them feel unloved. It's just really confusing." He just nodded, like a wise little owl. Disappointed, because he's smart and he knows this means he's probably not getting the cell phone he wants. But appreciative of the honesty.

I realize sometimes that he's scared too. He truly gets beyond himself sometimes, and he's wracked by guilt. After engaging in outrageous acts, he comes close, hovering near us for days, as if seeking comfort from the uncertainty he's created for himself. He's quiet and pensive and small, taking naps next to us on the couch and sitting silently in the kitchen while we cook, tracking us with his giant eyes. I truly admire him - I admire his strength and his humility as he grapples with his demons, and tries to get up and continue forward.

For Christmas this year, I'm aware of what this season of heightened expectations and requisite merriment is like for people who struggle to make sense of their world. I'm very grateful for the presence of a really good psychiatric nurse practitioner who entered our world recently, and a gifted counselor who has stuck by him through a year of phenomenal ups and downs: through bottoming out, successfully seeking treatment, relapsing, and reconsidering. I'm grateful to an old friend who helped us when we were falling apart, and a new friend who gave him a place to sleep when no other sane person would have taken him in. I wish a blessing for mothers and other mothers whose selfless mind-expanding love for a child makes them vulnerable and confused in the face of that child's illness. I wish for him and his brother peace and compassion in the coming year. I wish for all of us a world capable of evolving to a fuller understanding of human complexity that allows for the fact that not everything is a matter of discipline, and that not every dilemma has a solution.

Honestly

Ah, sigh. We're in a down cycle. It was bound to happen.

At times like this, I'm often aware that I'd like to be a therapeutic parent, capable of endless patience and commitment, but I'm too human to achieve that. I get tired of the cycles. I find it hard to strike the right balance between warmth and compassion, on the one hand, and reasonable limit-setting on the other. I find an average of extremes more often than I find true balance; parenting him is like sailing, leaning into the wind of love and connection one minute, and then suddenly shifting to the other side and using your weight to provide discipline and structure. Just when I think we've hit a patch of calm water, a gust comes up and we're off again.

An acquaintance recently said to me in passing when I was describing some new challenge with T, "Oh, he's just a typical teenager." But he isn't. It might look that way to outsiders. We deal with many of the usual teen issues - sex, driving privileges, parties, curfews. The difference is that a typical teenager (hopefully) went through a period of loving attachment and parental limit-setting ten or fifteen years ago, and despite the gale force of hormones and teen brain development mitigating against sanity, they formed basic habits of self-governance. That just isn't true with a kid like T. He might seem like a regular teenager (often he even seems hyper-disciplined) to someone who sees him for a few hours, but at home, things are quite different. There's a lot of chaos and confusion and cycle-rinse-repeat that goes on at our house. As my mom always says, it's like parenting a three year-old who is six-foot-three and can drive a car and is simultaneously experiencing all the physical and psychological changes of adolescence.

There's a reason we humans first attach to our mothers, then go through our toddler years, and only later, go through adolescence. It's very turbulent to go through all of those stages at once. When other kids were learning to accept limits from a loving, attached parent, T learned that nobody is looking out for you. He learned to keep his instincts on high alert because misfortune could (and often did) befall him on a regular basis. He learned that a hint of anger or frustration in someone's voice might signal life-threatening violence in the immediate offing. He learned that nobody could ever understand his needs, nor would they want to meet them if they could. He learned that mistakes might bring extreme punishment or even abandonment. He learned that other people will use you and take from you and that if you want to survive, you need to be prepared to do the same.

There are days when, frankly, nothing works. It might take him until he's 30 to learn a new pattern. He might struggle with the same patterns for his whole life. I still want him to be safe and achieve a basic level of well-being. He works harder than most, and results are much, much harder to come by. What often happens despite our best intentions is that he makes a poor decision, and I get exasperated, and he can sense that. Then he feels shame, and that makes him disconnect, and then I feel guilty, and then we both feel bad. Eventually, we manage to pull ourselves out of that cycle and reconnect, and then we try all over again.

He makes me very, very aware of my own limitations and personality flaws, which is only fair, because I probably serve to make him feel his more keenly too. It's something to work on--and an aspect of motherhood that, in my opinion, is not often acknowledged in honest terms.

Compassion

Late one night earlier this week, T's friend confided in him that several years ago, she was sexually assaulted by a relative. His response to her was truly awesome, and so genuine. It gave him a chance to see how much he has to give, having spent some time addressing his own needs this past year. He was calm, humble and forthcoming about his own experience.

In counseling her, he borrowed things that we have said to him (including "I'm sorry that happened to you" and "That was not your fault - you were a child, and you deserved to be protected by adults"), offering them to her. It felt good to know that those simple words, which feel so inadequate when you're hurting so much for your injured child, must have helped him. He also offered her wisdom of his own, beyond compare, from the deep reserve that is a natural part of his character.

Perhaps the most difficult part of her story is that her father beat her when he found out she had been raped. Apparently she was just eight at the time. T just listened, and then offered that perhaps her father didn't want to think or know she had been hurt so badly, and so reacted in anger and confusion, but that didn't mean that what happened was her fault. He told her that she is beautiful and complete. And then he offered the loveliest thing: he told her that he will always respect her and listen to her, no matter what else happens in their friendship, and that she can talk to him about it anytime. He told her that as he had begun talking about his own experience, he felt better with time - and he said that as he recovered, he had been to see "how people really are" and "I stopped hating myself."

All of this was done in such a gentle way. He has an extraordinary natural ability to turn the extreme suffering and loss he's experienced into deep compassion and an ability to hear and nurture other people. He wanted to talk about it with me right away - I think he was a little surprised how much he had to offer. There is something I can't capture in words about his gift in this regard. He not only listens and offers soothing words - he has a supernatural ability to project and extend an atmosphere of calm that is like the antidote to trauma. I picture him like a superhero in this way, able to detect suffering in others and cast out an invisible net of safety that catches and transforms pain into wisdom. When he was a little superhero, I think that he was still so riled up by trauma himself that he couldn't understand his gift. Now, sober and awake to the world, he sees what he's able to do and he's in command of his abilities. It was clear watching him this week that her confiding in him gave him the chance to share his signature gift with someone he loves, and that in turn contributed to his well-being too.

I am often struck that kids who have suffered like they have need just one compassionate person to receive their story in the right way for a great deal of healing to happen. It is a beautiful thing that he can be that person and I sometimes feel like I am very privileged to be parenting someone who is incubating such an extraordinary gift.

Free

A brief catchup on the juvenile court case we've been sorting through. Finally last week, with a whisper rather than a bang, the whole case against T was dropped altogether.

We went through three court hearings and more than a month of house arrest before we got to an ajudication hearing (the juvenile court equivalent of a trial) at which the DA stood up and said that the prosecution could not proceed, on the basis of a lack of evidence of his guilt and a preponderance of evidence of his complete and total innocence.

I have almost nothing to say about the experience now. It was brutal and racist the way he was presumed guilty of something that logic and common sense proved he could not possibly have done. I have always been someone more prone to carry on in righteous indignation than to change the subject. But I find that certain events, and this is one of them, just defy my ability to comment. The stark fact of it is enough: my teenage son was taken out of his own bed in his pajamas by seven police officers who invaded our home with guns one morning, handcuffed him in the courtyard in front of the neighbors, took him to juvenile hall, and held him for nearly a week. He returned home on house arrest for a month awaiting trial, only to be told in the end that it was all a big mistake. He had been falsely identified, and there was no case against him.

He stayed calm through the whole thing, and I was proud of his forbearance. The only thing I will add here is that T observed after the fact that "had I still been in the system" (by which he means in a foster group home, rather than with pre-adoptive parents), "I would have stayed in juvenile hall and probably nobody would have believed me that I didn't do it." I think he's right. His arrest was enough for child services to decide that he was no longer their problem - at the time of his arrest, his social worker assumed he was guilty and told us that he belonged on probation and they would not help us get him home. We had to implore the juvenile court judge directly to get him released to us. It was stunning to see how quickly a child in his position can get swallowed up in the juvenile justice bureaucracy - and how much difference parents (and, eventually, a good volunteer attorney provided for us by a friend) can make in slowing down a voracious system.

But Beautiful

Yesterday, we were in a requisite training class for parents of "severely emotionally disturbed children." It was a stormy, rainy day. The classroom was warm and bright and there were about ten other parents there, all of them parenting traumatized kids. When it came my turn to introduce myself, I cried. That's very rare. (As emotional self-expression goes, I specialize in righteous indignation.)

I said that we had been in T's life for two-and-a-half years, and that in that time, he had been arrested twice, expelled from two schools and a rehab facility, and that he had just hit his five-month sobriety mark. To my left sat a father of a 7 year-old girl who was in seven different foster homes before coming to him. Across the table sat a woman with two children who are receiving intensive in-home wrap-around services 6 days a week. To my right sat a couple who are parenting severely traumatized siblings with an emerging constellation of troubling and risky behavior.

In other words, I was in safe company. And I suppose that's why I cried. This year, I spend so much time explaining T to police, judges, therapists, social workers, teachers, administrators to try to stave off their anger and preconceived notions--but I didn't need to do that here. I didn't need to minimize his problems, insist on his personhood, or explain that I love him more than I even thought it was possible to love another person. Nobody thought I was an enabler, an apologist, or crazy. Every mom and dad in the room is living a variation on the same story. A lot of them cried as they introduced their circumstances, too.

The curriculum was relevant, a manual for navigating the aftermath of tragedy and trauma. After our time in the trenches, I find that some lessons hit me hard and others are familiar old friends (the section on appropriate discipline, for example, is old hat by now). I was particularly pained and enlightened by a section about prenatal drug exposure. The course material captured the straightforward observation that kids who have been drug-exposed in utero are at increased risk of abuse and neglect in later childhood. It explained that such children are usually born into already-fragile families or placed in infant foster care. Many struggle with impulse control, fine motor skills, executive function, anxiety, over-stimulation and self-soothing. The resultant behaviors then make them targets for adult frustration, impatience and anger, leading to a much higher incidence of abuse, neglect and abandonment. Alienated from peers and caregivers, they are also vulnerable to other forms of exploitation and manipulation, including sexual abuse, because they exist "on the fringe".

Reading that made me want to howl. T is one of those kids. Somehow I had never considered his story in quite that light. It was stark, and statistical. I felt shocked that such a narrative of misfortune could be so common as to have made it into a book in such plain terms.

Without minimizing that painful reality, I want to emphasize that the story has another part, one that is rarely understood: it is possible to make a difference, a huge and permanent difference. I want to add a paragraph to that section of the course material so the next parent or potential parent to read it will be reminded that you don't need a psych degree, a magic wand or a hazmat suit to be there for such a child. I want the course material to say: you'll never see the light of the human spirit burn so brightly as it does in a kid for whom everything conspired to extinguish that light, but who kept it alive in the hope that someone else would come along and recognize him. A child who infuriates one adult can delight another, and souls connect in a place beyond behavior. I know that's true, too.

When we got home from the class, we went out for dinner. I remember when T would only eat fast food, because he couldn't tolerate unfamiliar food, and he was too shy to order in a restaurant. But last night was relaxed and quiet. He ordered his food, choosing something from the menu that he had never tried before. He spoke directly to the waiter, and stated his preferences clearly and politely. He ate heartily. He appeared relaxed, and even chatted a bit in between sending text messages. It's a small change, probably invisible perhaps to anyone other than his parents. But beautiful.