display | more...

Welcome back, to Adverse Childhood Experiences, and I have been thinking about Erikson's Eight Stages of Psychosocial Development.

These were mentioned in medical school and in residency. I was in medical school from 1989 to 1993 and in Family Practice Residency from 1993 to 1996. Family Practice is at least half psychiatry, if you have time. We are losing the time with patients in order to achieve "production". I complained about the 20 minutes I was allotted per patient and was told that I should spend 8 minutes with the patient and 12 minutes doing paperwork and labs and calling specialists. This is why I now have my own practice. A new patient under 65 gets 45 minutes and over 65 gets an hour and my "short" visits are 25 minutes. I am a happy doctor. And on the Boards last year I scored highest in psychiatry....

So, back to Erikson. The first stage, at birth to one year is Basic Trust vs Mistrust. "From warm, responsive care infants gain trust or confidence that the world is good."

I was taught that people would have to "redo" the stage if they "failed". Let's look at that a little more closely.

Take an infant in a meth house. No, really, there are babies and small toddlers that have addict parents, alcohol, opiates, methamphetamines. We do not like to think about this.

A social worker told me that the toddlers from a meth house were really difficult to deal with. They do not trust adults. The first thing they do in foster care is hide food.

Hide food? Well, adults on meth are not hungry, sometimes for 24 hours or more, and they are high. So they may not feed the child.

Now, should this child trust the adult? No. No, no, no. This child is adaptable and would like to survive. So even under three they will learn to hide food. In more than one place. This is upsetting to foster care parents, but perfectly understandable from the perspective of the child.

So has the child "failed" the first stage? Well, I would say absolutely not. The child looked at the situation, decided not to starve and learned not to trust adults and hid food. Very sensible. Adaptive.

Is the child "damaged"? That is a very interesting question. After 25 years of family practice medicine I would say that no, the child is not damaged. However, the child has started out with a "crisis" brain. The brain is plastic, all our life, and so this child did what was needed to survive.

Is the child "sick"? Again, I would argue no, though our society often treats the child as sick. We think everyone should be "nice" and "warm" and "why isn't he/she friendly?" Well, if you started in an addiction household or a crazy household or a war zone, it would not be a good adaptation to be warm and fuzzy to everyone.

How do we treat the adult? In a warm fuzzy nice world the child would have a foster parent who adored them, was patient with them, healed them and they would be a nice adult. I have a friend who said that his foster care was so bad that he chose to live in an abandoned car his senior year rather than stay in foster care. He couldn't play football because he had to get back to the car and under the layer of newspapers before it got too cold. I am sure that some and hopefully most foster parents are total wonders and angels. But some aren't.

I have a person who says that he lived on the streets from age 8. He did get picked up and put into foster care. He kept running away. "The military loved me because I could go from zero to 60 in 60 seconds." That is, he has crisis wiring. He is great in a crisis. The military is a sort of a safe place, because it has rules and a hierarchy and stands in for the failed parenting. Except that then you get blown up by an AED in Afganistan and hello, that makes the crisis wiring worse.

How DO we treat the adult? We treat them horribly. We say why can't this person be nice. We diagnose them we drug them we shun them we isolate them we as a society discriminate against them deny them and we are a horror.

I get so angry when I see the Facebook posts where people say "surround yourself with only nice people". Ok, how dare you judge someone? You don't know that person's history. You don't know what they grew up with. How dare they say that everyone should be NICE.

I am a Veteran's Choice provider. I have 6 new veterans in the last 3 months. I suspect I will get more. They are not "NICE". They come in suspicious, hurt, wary, cadgy. And I don't care, because I am not "NICE" either. We get along just fine.

When I run into someone who isn't "NICE", I think, oh, what has happened to this person? What happened to them when they were little? What happened to them as an adult? How have they been hurt?

Pema Chodron writes about sending love: to your loved ones, to a friend, to an acquaintance, to a stranger, to a difficult person and to an "enemy".

Send love. And do something about it. Help at your local school, help families on the edge, help single parents, sponsor a child to a sport if their parents can't afford it, pay for musical instrument lessons, do Big Brother/Big Sister, become a "grandparent" to a child at risk, be a good foster parent, donate to addiction care....

The Devil Makes Three: For Good Again

Log in or register to write something here or to contact authors.