Wednesday, August 06, 2014

Enmeshment and a Proper Ending

We haven't talked about family of origin in awhile, so why not get back to it. I was going to write about guilt, anyway.

I have an optometrist who made me a pair of rimless glasses about fifteen years ago, glass.  "Treat these like jewelry," he warned. "They are very fragile."


Random building, random car, not the car
or building in the story
.
The Story:
Five or six days out of the week I swim. At the same time, as I walk into the looming multi-unit building, a frail older man in a white shirt and tie, black suit and hat, is leaving. A large SUV waits at the curb. The gentleman struggles with the passenger front door, steps up carefully into the car. He and his driver are likely off to morning prayers.

The windows are dark, but I assume the driver is his son. I can picture the older man tossing the cane into the back seat.

Hating myself for judging, it bothers me that whoever it is picking him up, for whatever reason, hasn't popped out of the car to help. It is what I did for my mother at any opportunity, pop out, although she complained.
"I can do it."
She couldn't.

My bad for that? Should I have respected her need, her desire for independence, the very thing we crave most of our lives, especially in the more traditional marriages, marriages like hers, as in, serving-is-just-what-we-do? But I wouldn't have dreamed of letting her risk a fall while struggling with a car door. Any fall at that age is critical. The recollection of her broken pelvis as a younger woman is enough.

But giving the benefit of the doubt, the resident is a man, after all, if an older man, less brittle perhaps. Maybe the passenger sternly warned the driver:
 "I am not an invalid. Do not insult me. I can get into an automobile." 
Said with feeling, spoken with intensity, the lasting affect of a more youthful personality. And obviously, he can. The son shows respect. The father, surely at one time a person who drove his own automobile, has his autonomy. What choice is there?

And inside the car it feels intimate, it has to. Because as we lose height and balance, we suffer fewer niceties, fewer formalities. Less tip-toeing around feelings because there's no denying the need for doctors, medicines, help. Aging, accompanied by aches and pains as a rule, begs to be expressed. "How do you feel?" and the cork is popped. The answer, in a whisper or a roar, will be better in Yiddish.
Elaine Stritch on NPR's Song Travels

Elaine Stritch recently died, but worked well into her last years. Even before reaching a certain age her style was direct, honest. Comedians get their laughs precisely for that, their honesty and self-disclosure. Even their memoirs are intimate. Watch famous younger actors fawn over Ms. Stritch in Shoot Me. The actors want a relationship with her, want her time. It is more meaningful than a random act of kindness to a stranger, not that helping someone across the street feels bad.

So fellow actors, make-up artists, coffee fetchers and valets will grieve an actress like that.

Of course, they aren't family.And let's not forget, there are old people, and there are old people. Generalizations about intimacy are meaningless when people age mean and difficult.

Which brings us to a few dissertation questions for the graduate student's consideration.

Long-term outcomes of childhood enmeshment

(1) Does childhood enmeshment predict a good result for the aging parent?

We assume it is bad for the child, especially toxic for a teenager who is denied a life, who cannot run with friends, socialize or leave home for college,individuate, become his own person. And it is bad for younger children, too, never having play-dates, missing school to stay home with a needy parent. All because of a psychological (and sometimes physical) need for control and attention.

But does it work for that parent during those senior years? Or is it payback time.

(2) Does childhood enmeshment predict depression, anxiety, substance abuse, etc.? Fill in the blank.

Does an enmeshed child's mental health fare that badly over the course of a lifetime?

Studies would have to control for confounding variables, like the degree of enmeshment, degree of psychopathology, characteristics of the adult child, the parent. Keep it simple for a dissertation.

In some cultures enmeshment is an emotional death sentence for the oldest or youngest daughter, destined to care for her parents, not to marry and move on. But usually enmeshment is less formal, isn't reserved by birth order. It is the coddled son who never marries, who is still living with his parents well into middle-age and is drinking with them on the couch in front of Dancing With the Stars.Or a family like we see on Everyone Loves Raymond. 

Logically, over-involvement, interference, should predict anger, but it might not. (Alcohol keeps it in check, and humor can, too). But the guilt associated with the very thought of leaving home has its own sedating effect, is my thinking.

For those of us who treat family problems, who see the way the family operates as a having an impact upon mental health, another question is relevant. What can we do? There is a field of outcome research that evaluates the efficacy of our interventions. I'm proposing one here. Call it, the future tripping intervention. A more professional term would be
  projecting into the future  
A final research question then,

3) Does projecting into the future function to dis-enmesh families that have problems with one generation respecting the physical and psychological boundaries of another? Narrow this down, of course, focus and study in-laws and their adult children.

It is the adult child who comes to therapy, generally, alone or with a partner, and many therapists leave the invasive in-laws out of the treatment intentionally, assume that it is healing for the patient to buck up, assert. The asserting is scripted, sometimes as an unimaginative ultimatum to the parent:
"If you can't stop . . . then. . . we'll move away." Or more typically, "won't answer your calls."  Fill in the blank.
The famous moratorium. Sometimes it works, but it is painful for everyone, and feels like over-kill. Parents with personality disorders will find ways to make the child feel even worse, will sabotage or retaliate. Parents who are less disordered might miss the entire part about the family's overall mental health.

Include them in therapy and it is another situation entirely. The therapist is a witness, one that will validate, certainly to a degree, rather than an attack the older generation, the one that ostensibly is responsible for the enmeshment. They need help, after all, do they not? Therapy should feel like an unanticipated benefit, enacted well. Add the projecting into the future, what it will be like when these people will really need attention, and the thought that by that time their children may resent the inconvenience (not that they do now, but in the future. . .) and you have a winning hand.

Nobody wants their children to have a mid-life crisis and abandon them at the worst possible time, about the time they can't find their reading eye-glasses.

Always use abandonment fears in therapy when you can.

Projecting into the future isn't an intervention only for enmeshment, but a natural technique in any type of multi-generational family therapy. Any family-inspired mental distress will do. It is useful, especially, when the parents have been abusive. Abused adult children often still seek the love, want it, which explains why many take care of their parents at the end, no family therapist need apply. But it is a gamble for the abuser to depend upon that.

So to me, seeing that SUV, the father-son relationship played out in the early morning, is a snapshot full of possibilities. I want to know how they got there, how he got to be the good son. Or was he always that way.

therapydoc


1 comment:

Jenny Noble said...

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