Tag Archives: Parent

Drip, drip, drip (better times up round the bend)

25 Friday Jun 2021

Posted by in empathy, Evil, kids, love, marriage, my awesome husband, narcissism, PTSD, Rape, romance, Sin, Uncategorized

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Water torture encompasses a variety of techniques using water to inflict physical or psychological harm on a victim as a form of torture or execution

I’d like to start this post by pointing out the term “Chinese water torture” is racist and nonsensical actually. When this torture technique has been used, it has been mainly by Europeans and there’s no recorded instances of the Chinese ever having used it.

Ok, onward and upward.

There’s this book by Lundy Bancroft I bought years ago titled “Why Does He Do That?” It’s about abusive partners and the many myths that surround our ideas of abuse. He’s a counselor that works with abusive men who either want to change or have been forced by the courts to undergo counseling. We often say abusive men need to learn to manage their anger but Bancroft argues that abuse isn’t an issue of out of control anger. Rather, it is a systemic, deliberate process used to control for the benefit of the abuser. They don’t need to learn to control themselves; they need to learn to stop controlling their partner (and everyone else in their lives they’re controlling).

In the book, he details ten different categories of abusers. The one I am going to talk (err-write) about today is the Water Torturer.

We’re all familiar with the idea of water torture. Not the waterboarding done by the US government. Rather, this idea of tying someone down and dripping water down onto their forehead slowly, drip by drip. The drops come randomly and it induces a psychological breakdown.

Lundy uses this as a metaphor for the kind of abuser who doesn’t yell or hit. He is always calm and appears to the outside world to be a great guy. He rarely slips up and lets anyone see what he’s really like. He knows how to push his partner’s buttons and get *her* to scream and get emotional. Then he says “why are you getting so worked up?” “you really need to work on your mental health problems” “stop abusing me.” He doesn’t punch or kick but he engages in subtle physical abuse such as blocking her from leaving the room or following her around the house arguing when she tries to get away. He doesn’t engage in blatant sexual abuse such as rape but rather makes degrading comments about her sexual interests, her appearance or withholds sex. He makes extensive use of sarcasm, put downs, controlling where she goes, controlling money, undermining her sense of self worth, isolating her from friends and family, badmouthing her to other people and gaslighting. Lots and lots of gaslighting.

Because you see, like Harry Houdini who helped popularize the idea of water torture, he depends upon an illusion to keep her with him. He depends on creating distractions so neither she nor the outside world can see what he really is and what he’s really doing.

The good news, friends, is that you don’t have to remain strapped down to that table. The damage done by this abuse is extensive, but most definitely something you can heal from.

You just have to keep in mind the Wizard of Oz is not real and keep your eyes on the little man behind the curtain. It’s hard to do, but you’re a badass so you got this.

I see this a lot in my practice. I have women who come in with black eyes and broken ribs, but more often they come in telling me stories of emotional abuse like this. They’ve been so worn down by it, like a pebble in a stream that becomes small and smooth over time from the water flowing over it. They are too tired and broken to leave. And they’re in love. And they’re addicted to the chemicals our brains grow to crave when we’ve been in toxic, tumultuous relationships for so long.

The University of Illinois did some research and noticed there are 5 stages to leaving an abusive relationship. The first two stages encompass the very beginning of the abused partner noticing there is something very wrong, something that goes beyond normal relationship issues. She’s nowhere close to leaving, but the spell has started to wear off. Stage three, women start to notice the effect of the abuse on their children. They start viewing the abuser’s behavior as abuse on a regular basis. And they start preparing to leave. Maybe they tell a friend what’s going on. Start stashing away cash in case they need to run. Call a domestic violence line. Stage four is an interesting one.

Stage four is the yo yo stage. You leave but then you come back. You might end up yo yo-ing several times before you truly leave. Why? Because he says he’ll change. Because being on your own is hard, financially, logistically (with kids), emotionally. Because he gets other people to guilt trip you. Because he won’t “give up on you.” Because you’re addicted to the brain chemicals. Because this dynamic is comfortable to you. Because you love him.

Stage five is the final one. You have left and you have stayed away and aren’t going back. The researchers define this as having left and stayed away 6 months or more. The abuse can continue if there are children involved and you are forced to have continue contact with your abuser, but it’s much less than before and you can begin to heal and move on.

It’s hard as doctor to have patients in those first four stages. Hard for friends and family too. But you can’t skip stages and you can’t rush someone through them. They have to make the choice to leave and stay left. You can support them by listening without judgement and validating their feelings. If you’re a friend or family, offering help with kids and other logistics can help too. And if they yo yo back, be there for them. They may be afraid to tell you. They may avoid you. Don’t give up on them. The abuser will likely make even greater attempts to isolate his partner if she goes back, so stay in her life whatever way you safely can and let her know you’re there is she ever needs you.

A lot of doctors shy away from dealing with the issue of intimate partner violence because they find it so frustrating to have a patient that won’t leave or who goes back. There are a lot of reasons women stay or return. And the sad reality is, sometimes it’s safer or necessary for her to stay. Being there to keep her as safe and supported as possible is hard, but it can be life changing for her. If you abandon her because she won’t leave, you’re just continuing the patten of the abuser, seeking to control her.

The longer you stay, the harder it is to leave. So, if you’re in a relationship with a water torturer, don’t put off considering leaving. A lot of times the reasons we come up with to stay aren’t as convincing if we discuss them with someone outside the relationship like a therapist, domestic help line or friend. Once you’re down in his world of gaslighting, isolation and control, your sense of reality is skewed. You need someone who isn’t riding that Tilt-A-Whirl.

Once you are out, the healing is not necessarily the most fun process. It’s kind of like when someone is getting over opiate addiction. There’s a lot they need to dig out from. A lot of pain and sadness and the practical part of rebuilding your life. But there’s also joy. And as the months pass, there is less and less pain and more and more joy. And you will look back and say, how did I do that all those years? How did I survive? And you’ll see what a badass you are. And that there are far better things at the carnival than the broken Tilt-A-Whirl. And you and your kids will eat cotton candy and laugh and sleep soundly at the end of the day cozy in your warm, safe beds.

40 Days and 40 Nights (or, what doesn’t kill you also makes you more grateful (if you let it).

03 Sunday May 2020

Posted by in Catholicism, christianity, doctors, empathy, kids, love, medicine, parenting, PTSD, Rape, residency, Uncategorized

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We have now had a fever for 42 days. Off and on. Mine had gone away yesterday and I thought, maybe this is it. Maybe this was a fever that lasted 40 days and 40 nights, that started two days before I stopped being 40 years old. And maybe if that’s true, there is a deeper spiritual meaning to it. So, I researched the number 40.

They say 40 in the Bible essentially means, a really long time. It rained for 40 days and 40 nights when Noah was out on the ark. The Israelites wandered in the desert for 40 years. Moses’s life is divided into three 40 year phases. Jesus was tempted by Satan for 40 days. He stayed with the disciples 40 days before ascending to Heaven where he is seated at the right hand of the Father.

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They also say 40 represents a new beginning. It has to do with it being a factor of 5 and 8, and 4 and 10. I will skip over those details. After 40 days, the flood receded and it was a new world. After 40 years the Hebrews were considered to have paid the price for their disobedience and given a new life in the promised land. After 40 days, the Holy Spirit anointed the disciples and they were reborn. In Judaism, the embryo is considered to be formed at 40 days gestation. And a pregnancy lasts 40 weeks.

It also represents water, baptism, mikvah. There is the great flood. In traditional Judaism a woman goes to the mikvah ritual bath for purification 40 days after having a son, 80 days after a daughter. The mikvah is filled with 40 seah of water.

According to the Jewish Talmud, at 40 years old you gain the gift of understanding. You come to begin to fully understand all you’ve been taught.

I have been feeling exhausted lately, burdened. And feeling like I will forever be wandering in the wilderness, the promised land always just slightly out of reach. Time and again telling myself, you just need to get through this phase and then things will get easier. At what point do I admit to myself it’s a lie, that this is as good as it gets? In other words, I have been hopeless and have lost that sense of possibility I’d been so grateful to regain back in 2015 when my PTSD was healed.

My life is better than a lot of people’s and I know this in my head and I know this in my heart. But their suffering did not seem to alleviate mine. I kept telling myself to get over it, but I just couldn’t.

Perhaps it’s the nature of this fever. You feel good for a day or two or three. Really good. And you’re so grateful. You have energy and joy and you can run and get things done and enjoy life. And you think this is it, I’m better. I can get on with my life. And then it comes back.

Perhaps it’s this quarantine grinding us all down. Or the fact I had three people close to me in my life a year ago and now I have none. And I’m in isolation and can’t replace them. I cannot picture my future because none of us can. We do not know what will happen with the economy, with the pandemic, with the election, with the way things are done and the way we relate to one another. And so, how do we have a sense of possibility? There are infinite possibilities and none at all.

And so I looked to the number 40 for hope. If my fever lasted 40 days then maybe there was a divine reason God had allowed it to go on so long. Maybe God had a plan for me. Maybe beyond 40 years and 40 days and nights I would emerge from the wilderness and finally enter the promised land. Purified and born again.

But here I sit on day 42. Maybe sometimes a fever of unknown origin is just a fever of unknown origin.

I had the energy to play with my daughter today. She couldn’t believe it. We ran shuttle runs and played charades and had a jumping competition. I felt great. For now, I’ll take that and be grateful. We’re not promised a damn thing in this life. If I ever return to good physical health and energy I will be grateful in a way I couldn’t have been before. When we emerge from this quarantine and I can be with my patients in my office again, I will be grateful in a way I couldn’t have been before. And when the second forty years of my life are easier than the first (and they will be. I know this much is true), I will be grateful in a way I couldn’t have before.

I hate the saying what doesn’t kill you makes you stronger, even though it’s true. I mean, what a crappy gift: the knowledge now you can make it through something even more awful. But this truth has saved my butt more than once and I put faith in it that my children’s difficulties have done that for them. Because life is hard and the best thing we can do for our kids is prepare them to face whatever it throws at them without falling apart. But what doesn’t kill you also makes you more grateful (if you let it).

I’m grateful for my kids’ fever because at one time their immune systems were so dysregulated, their bodies couldn’t mount a fever response to invading pathogens. I’m grateful every time my 14 year old acts like a jerky teenager because he gets to a live a relatively normal teenage life now instead of being in PANDAS hell. I’m grateful every time I eat a meal without an abusive husband there criticizing what I’m eating or not eating because that was not always the case. I’m grateful to be a doctor, the good and the bad, because it was almost taken from me and I gave literal blood, tears and a piece of my soul (and my cervix) to get through my training. I’m grateful for the sense of possibility because for so many years in PTSD, it wasn’t there as I dwelled in that place between life and death.

So maybe that’s what the promised land really is: gratitude. If we never wandered through the desert for forty years, how could we even know we were in the promised land? Maybe it is not a static place, this promised land. Maybe it can’t be. Maybe it’s an oasis where we replenish ourselves and get a rest before heading out again. We never know how far into the wilderness we will go and for how long, but we know the promised land is always there. Until we reach the end of this life and enter the world without end and find that possibility we have been been seeking once and for all.

That choice is gone (or, This is hell. get walking)

06 Thursday Oct 2016

Posted by in christianity, Evil, kids, love, residency, Sin

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Mental illness kills.

It kills with heroin overdoses and self-inflicted gunshot wounds and anorexia induced cardiomyopathy and obesity induced sleep apnea and girls who take risks they shouldn’t with dangerous boys.

And when it does, there are usually kids left behind. And that is the worst tragedy.

When I was a resident, we would admit patients overnight who had failed at killing themselves with drugs. We needed to make sure they were medically stable before being sent to inpatient psych. The ER  had saved them but we were the ones to run fluids and monitor them and fill out the paperwork once the psychiatric hospital was ready for them.

It was the job of the residents to go see these patients at two in the morning and complete an H&P, a history and physical exam. We would ask the questions we asked all patients: chief complaint, onset, duration, intensity, chronology, exacerbating and remitting factors, associated symptoms. In this case, the chief complaint was not shortness of breath or fever. In this case, the chief complaint was, I wanted to die. So I tried.

Sometimes onset was a long time ago, often it was right beforehand. Intensity was of course always a ten. Sometimes they told you their story freely. Sometimes only the bare minimum. (we would write “history limited by non-cooperative historian”)

I remember one patient in particular. She was a mom. She had three kids around the same ages as my three kids at the time.  She told her story of how her boyfriend had hurt her. Hurt her so badly she decided to die. I asked where her kids were when she took the pills. They were home with her. Maybe they’re the ones who found her and called 911. Maybe it was the worst night of their lives after many other bad nights. She didn’t know whether they’d found her or not. She didn’t care. She never asked us where her children were now. Just went on about the boyfriend and how he’d hurt her and how hurt she was. And I tried very hard to have compassion for my patient, but all I could think of was her kids. Of how badly a successful suicide by their mother would have wounded them.

I have never been the type to lack compassion for those so hurt inside they feel killing themselves is the best solution. I have heard good Christians say they will go to hell. I have heard people call them selfish for hurting their families and thought, do you have no grasp of how much pain they must be in?

But by this time, at the age of 34, I’d lived a bit more of life and had a more nuanced view, you could say. I still think its’s awful to say they’d go to hell. But I do not think, when children are involved, we can simply say they were ill, they were in pain, and so it was.

When I was 28, I had a boyfriend too, just like my patient. He broke my heart too, just like my patient. And I decided to die too, just like my patient. I planned out which pills I would take and when. I’d just had pharmacology before Christmas break had begun and knew which ones would be most effective. It was Christmas. The tree was up. I hadn’t given my kids their presents yet. We were alone in Erie for break. I decided I would drop them off with their dad. He would take them to his parents house for several days for New Years as he did each year. No one was expecting to hear from me. It was time to die.

I was in a depression as deep as any I’d been in many times before. But this time was different. I was 28. I’d been battling depression since I was ten. I always held out hope I would get better one day. Life held so much possibility. But at 28, I thought, here I am again. I can’t keep doing this. I can’t. I sat on my floor crying as my three year old and two year old asked what was wrong and brought me Children’s Tylenol to try to make me better. I hate that I did that to them. I am sorry that I did that to them.

I kept pulling presents from the basement and giving them to them one by one to keep them occupied. I fed them leftovers from the Christmas eve party at my family’s house I’d brought back. I suppose I changed their diapers. I don’t remember.

I planned out how to die and thought, they will go live with my parents and be so much better off without a worthless mother like me. But then it happened.

I entered into rational thought long enough to realize they wouldn’t go live with my parents if I died. They would go live with their dad. And their dad, luckily, was a tremendous asshole at that time. And I thought, I’m really worthless, but he’s even worse. Thank you God he was such an asshole. I couldn’t do that to them.

I remembered when my oldest son Soldier Boy was a baby and I didn’t know if he would live because of a genetic disorder they thought he might have. I remembered sitting in the glider in the nursery wailing a gutteral wail from as deep down as a person can, begging God not to take my baby. Put me through the pains of childbirth for all eternity, I said (I’d just finished a 32 hour natural birth so that’s no small statement). Put me through hell, I said. Just save my beautiful baby.

And he did.

And I thought to myself, I am in so much pain. It hurts so much to live. I am in hell. But now it seems I must do what I told God I would. I must walk through hell for my babies. And so I did. One step at a time.

When you are that depressed, finding the will and the energy just to get out of bed in the morning is excruciating and exhausting. But I did. I got out of bed and I took care of my babies. I went to class and studied. I called a psychiatrist’s office and was told they don’t take Medicaid. That about did me in. But I made myself call another. And I got a psychiatrist appointment for a month from then and a therapy appointment in a few weeks.

I kept breathing. I kept living. Every breath hurt. My heart ached. My muscles ached. My soul was not in my eyes if you bothered to look. Luckily no one looked.

I wanted to check myself into inpatient psych but I knew if I did it could ruin my career and I could get my kids taken from me. I was right. I’m glad I didn’t. But it hurt. It hurt so damn much.

It was in this time, this darkness, this exile, waiting to see a psychiatrist that I entered into the relationship with the man who was my trauma, who was my Ordeal. I was in hell, so I laid with a demon. I suppose.

There in the midst of my Ordeal, I made my way through hell. I chose to live each and every day in every decision I made. When I did not feel like getting out of bed,  I would say to myself, you either live or die. If you stay in bed, you are choosing to die. When I didn’t want to go for a walk to get exercise and fresh air, I would say to myself, you have two choices, life or death. If you do not go on this walk, you are choosing to die. And that is not an option. Your babies need you to live. This is hell. Get walking.

I do not know how it is that a part of me found wellness inside the trauma, the Ordeal. Sometimes I think it’s that a part of me, a version of me, broke off and endured the trauma while the rest of me went on with life as usual. Sometimes I think it was the adrenaline. Sometimes I think it was God. Maybe a little of each.

I know that with my therapist and my psychiatrist I got to a point where I could do a load of laundry without exhausting myself. Where I could study and enjoy neuroanatomy and feel proud of myself for rocking the exam. Where I could play with my kids.

Then came PTSD, but that’s another story for another time.

And so this is what flashed through my mind and heart when I stood there collecting this patient’s onset and chronology. For her chief complaint of choosing to die. This is why I could not lend her more compassion.

When we choose to have children, certain choices go away. Dying is one of them. Even when living is hell.

And to not die is not enough. We must choose to live every day in every choice we make. We must fight for our children. Even when we can’t bring ourselves to fight for us.

They are innocent. We are not. The body is weak, but the will is strong. Must be. For them. This body, this mind, this pain, is not endless. It will all fall away. Ending it a little sooner is not worth the price of their innocence.

It is not a choice. That choice is gone.