In Pursuit of Good Enough

A blog about therapy, parenting, and life

On Veterans Day

November 11, 2016

In recognition of Veterans Day, I was asked to give a talk at a senior center in Brooklyn.  I reworked that talk into the following blog post.

Whenever I happen upon a veteran, or the family of a veteran, I make an effort to thank them for their service and their sacrifice.  Our country called on them to give what they could, and they did.  You never know what it will be that you’ll need to sacrifice when you answer the call to military service, but they did it, whether by offering themselves or by supporting their spouse or child in their military service, and for that the entire country owes them tremendous gratitude and honor. 

I have come to know a few things about the kinds of sacrifices our military veterans and their families make for our country as a result of my family history as well as my professional training.  My grandfather (who died in 2001 and is pictured below) served as a Captain in the Army during World War II, during which he was in North Africa as well as Europe.  My grandmother, who is nearing 94 years old, talks about the time during which my grandfather was away serving in the war as being very difficult and uncertain.  She was raising her young son Jack on her own, trying to help her parents raise her several younger brothers and sisters, and concerned about whether or not her husband would ever make it home.  Fortunately he did, and they went on to have two more children, including my father, which allows me to be here today! 

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But, despite my grandfather’s obvious pride in his service, his time during the War was not something he wanted to speak of much upon his return.  Rather, he chose to put it all behind him and to resume his life as a farmer.  His children and his wife knew very little about his service and those long and dangerous years he spent abroad.  I do wish he were still around so that I could find a way to ask him about that time given what I have learned about veterans’ experiences since then. 

I am a clinical psychologist.  I received my doctorate in psychology from Long Island University in 2010.  Prior to my graduation, though, in 2009, I began a formative year of clinical training at the Veterans Affairs Hospital in Dyker Heights, Brooklyn.  The veterans at the Brooklyn VA take great pride in “raising up” student doctors.  Many said to me that they looked forward to explaining their experiences from their military service to my colleagues and I, and trying to communicate exactly what Post-Traumatic Stress Disorder, or PTSD, was for them.  They knew it was a training hospital and that this was the only way to create doctors who would understand what they had seen and had to deal with, and to pave the way for future soldiers coming out of the service who would need our help.  As a student, at times, I naturally felt defensive about what I knew and the attitude that they as patients were going to educate ME.  I thought to myself, “I have gone through five years of education and training for someone to tell me I know nothing?”  But of course, I did know next to nothing.  One can have all the book smarts in the world, but still truly know very little about human suffering and psychology. What it takes to understand that is time, patience, listening, and really absorbing the experience and wisdom of others, really sitting with what they went through, what they saw, and what they lost. 

And that is what I was doing or trying to do every moment I was at the Brooklyn VA.  In addition to seeing patients in traditional one-on-one therapy, I saw patients in groups and I saw patients on medical units.  My first rotation was on the oncology and palliative care, or hospice, floor.  I came to know very well the more common cancers among veterans and the reasons for these higher rates, which include exposure to noxious chemicals used by our military or others.  Of course, no one tells you when you enter the military that you might be exposed to chemicals that will kill you, but it happens, and years later, you may experience the consequences.  While many would assume that someone in this situation would be angry, many of my patients had wonderful memories of their time in the military, with their buddies, seeing the world, doing a job, feeling competent and necessary.  Often I learned about their most meaningful experiences in the military from their spouses and families, rather than from them.  Some of them had no family by their sides in their final days, the sad result of too many emotional injuries for them to tolerate any more connections.  I sat with them through chemotherapy, through radiation, after surgeries, when they couldn’t sleep, when they couldn’t remember things, when they could no longer eat, after they could no longer talk, and as they were getting ready to die.  In my year at the VA, close to 90 of my patients passed away.  I think of them often and the gifts that they gave me.  I am grateful for the time I was able to spend with them, some not very long, and the openness and kindness they and their families showed me in these dark hours of their lives.  They helped me put the veteran experience in the context of the arc of a person’s life and to learn about some of the positive and negative results of military service to a person’s physical and emotional self.  I think that there is no more powerful experience than to sit with someone fully contemplating their life’s path and what it has all meant.

I also worked in the Pain Clinic, where I met with patients of all walks of life living with inconceivable levels of suffering, often due to injuries sustained during their military service.  The anger I witnessed there left me with greater awareness about the way that the body and the mind intersect and connect, and the importance of addressing the physical in psychology as well as the emotional.  Learning how to empathize with, tolerate, and help these emotionally and physically scarred veterans deserved a doctoral program all to itself, but I learned all that I could in the six months I worked closely with these patients. Among other things, they taught me about the benefits of yoga and meditation and how the attuned body acutely feels weather patterns and emotional states of others.

I also met with groups of Vietnam Veterans who, forty years after their service, still could not stop dreaming about their time in Vietnam, and would wake up, almost daily, feeling as if they’d just re-experienced the worst moments of their lives in the jungles of Vietnam.  For many of them, the survivor’s guilt that they experienced was so unrelenting and self-destructive that I became well acquainted with talking about suicide and helping veterans find reasons to keep going each day.  I learned about their insomnia, hallucinations and flashbacks, road rage, struggles with the yearly anniversaries of losses, and the challenges of marriage and parenthood when you have seen what they had seen.  I learned about the benefits of keeping busy, finding purpose in life, finding pleasant experiences in life each day despite the challenges, and avoiding self-destructive substances and impulses. 

I hope you understand that these are just a few examples of what I learned in my training at the VA. It would be difficult to put into words the depth and breadth of what veterans taught me during that very formative year in my life as a psychologist-in-training. Despite all the reflection I was doing, it wasn’t until I had finished my internship at the Brooklyn VA and was working as a psychologist on the staff of the VA clinic in Staten Island, that I came to truly understand the role that veterans had played, not just in my education, but also in the education of all clinical psychologists in the United States. 

After graduating, I was asked to teach a class on the History of Psychology at Long Island University.  In putting together the syllabus, I felt compelled to include the history of the diagnosis of Post-Traumatic Stress Disorder, since it has evolved dramatically since first being recognized as a mental condition that affected soldiers in the Civil War.  In researching what to teach my students, I found further confirmation that veterans are quite possibly the greatest teachers of all time.  During World War I, psychiatrists and academic psychologists were involved in assessing soldiers to determine if they would be able to withstand the challenges of combat.  During and after the war, many of those professionals were asked to evaluate soldiers who were said to be “shell-shocked,” or emotionally injured, by the experience of combat, and to figure out what to do with them, either by getting them back out onto the battlefield or by helping them rejoin their families back home.  The traumatized soldiers of World War I are not often discussed, mostly because the number of traumatized soldiers that came out of World War II greatly dwarfed those from the prior war.  But thank God for them, because if not, the medical and psychological fields would not have been even remotely prepared for what was to come. 

Instead, though, medical doctors and researchers became aware of this phenomenon of “shell shock,” what causes soldiers to be more vulnerable to it, what it looks and feels like, and some strategies for coping that do and do not work.  Initially, doctors just told soldiers to have a few stiff drinks and get back out on the battlefield! Today, fortunately, our advice is rather different.

When the United States entered World War II and men began being drafted, these psychologists were put to work evaluating soldiers once again, determining which were suited for which position, and which soldiers had already sustained too much trauma in their lifetimes to make them good candidates for combat.  Despite this screening process, many soldiers still went on to develop combat trauma, not to mention physical trauma that often left them with significant injuries.  Both of these problems increased with the dramatic surge in firepower seen in the weaponry advances between the two world wars.  American military hospitals were flooded with soldiers in need of treatment, and thus the hospitals were in tremendous need for doctors of all kinds.  Such began the VA’s training model of taking in student doctors and helping to make them into competent professionals.  This first impacted medical students, but soon enough, it became apparent that the soldiers also needed emotional help, and fast. 

While psychology was a small field at the time mainly centered around academic research and a few child-focused clinics, this demand for psychologists who could apply the research to helping adults alter their thinking and behavior led to an increase in students in existing programs and an increase in the number of training programs around the country.  The first students to work at the VA were learning directly from the veterans because there was no one else to teach them, no supervisors who had come before who had any expertise to convey.  In this way, the veterans were the patients, the experts, and the supervisors of their own care, feeding the students information and giving them feedback that would hopefully help to alleviate their symptoms. 

And so the field of clinical psychology began to take shape in the VA facilities around the country, spreading from academia and small pediatric clinics to large hospitals that worked with individuals of all ages. In the 1960s, the pre-doctoral internship program that gives psychologists-in-training a full year to work and be supervised by licensed psychologists before they can graduate was developed as a result of the VA training model.  Today, VA facilities in the U.S. train nearly 1,000 clinical psychology students each year.  When I stop and think about what would have become of the field of clinical psychology—and if the field would have come to be at all—I feel tremendous gratitude and debt toward veterans and their psychological struggles over the years.  Time and again, veterans have offered themselves up to their country, in times of war and in times of peace, in sickness and in health, in an effort to improve and protect our lives here in the U.S. 

Of course, the marriage between veterans and psychology has not always been smooth or rosy; in fact, many veterans remain suspicious and wary of psychologists, I think, in part because of the vulnerability and dependency it causes in them.  Knowing the history, though, I understand these feelings as well placed.  For many years, psychologists were afraid to admit how clueless they were about how to help veterans recover from what is now recognized as Post-Traumatic Stress Disorder.  Unfortunately, we still don’t have a very high cure rate for this condition, and that makes everyone uncomfortable.  The same is true for the increasingly common condition of Traumatic Brain Injury, or TBI.  For both the patient and the clinician, it’s very hard to accept the idea that someone may never fully recover from these conditions, while also holding out hope that they can and will improve and return to a productive civilian life.  It’s a difficult dance that we do that takes a lot of hope, honesty, tolerance, and trust.  I hope that research and careful consideration of veterans’ experiences will help fine-tune the treatment for PTSD and TBI and that the future will hold a cure for these awful and often emotionally paralyzing conditions.

After leaving the VA in 2013, I opened a private practice, and as it happens, I sadly I do not currently have veterans among my caseload, although I do supervise students who do, which is a wonderful way to pass on what I have been taught.  But I can attest that what I learned from veterans informs so much of my work today. For instance, when a woman comes to me having experienced a very difficult or even traumatic childbirth, I feel fortunate to have sat with veterans who have explained to me the recoil of disturbing memories that happens for them, as well as the complex emotions and thoughts about their identities that they grapple with.  When a patient whose loved one has died comes to me, I feel indebted to the veterans who have shared with me their many lost buddies, wives, friends, parents, and children.  When a patient comes to me with a chronic illness, I think of all of the veterans with whom I have sat and processed the day-in and day-out dreariness of chronic and sometimes terminal illness.  At times it feels as if the veterans with whom I worked, who trained me, are in the room with me, coaching me, reminding me, helping me to help my new patients.  I feel blessed to have had them as my teachers and to have been entrusted with their experiences, stories, burdens, and tears. 

On this and every Veterans Day, I am grateful for the generations of veterans upon whose backs and in whose service the field of clinical psychology was built.  It is because of them and their suffering that we know much of what we know about the human mind, and because of them that we must continue to learn and develop effective strategies for treating mental illness.  As a clinical psychologist, I am indebted to the veterans who have contributed to our knowledge and understanding of mental illness, but I would rather be out of a job than have more veterans needlessly suffer from Post-Traumatic Stress Disorder. 

As we celebrate this Veterans Day with a new President-Elect, I hope with all my heart that he fully appreciates the commitment and sacrifice that soldiers and their families make with each enlistment, and that he treats the role of being their Commander-in-Chief with the respect, caution, and thoughtful consideration that such a responsibility deserves.   

Posted 44 weeks ago

In Pursuit of Good Enough

It is rare that I don’t get a parent client who questions their skills and aptitudes for parenting most moments of the day.  And from my experience as a parent and clinician, I have learned that this is not a function of being a parent who seeks therapy but a function simply of being a parent. Kids test our boundaries, limits, priorities, feelings, triggers, knowledge, hard-won wisdom, and just about everything else we thought we knew and believed was clear and right in the world prior to having kids.  In return, we love them madly and deeply and yet often feel so conflicted about the base with which we provide them: Are we being firm and consistent enough?  Are we being too hard and rigid?  Are we being loving and supportive enough?  Are we being too soft and too much of a push-over?  In a nutshell, are we being “good enough”?  Ever?

This phrase, this idea of being a “good enough” parent comes from psychoanalyst Donald Winnicott’s belief that being a good parent is not about being a perfect parent, one who is seamlessly attuned to the child’s every need and want and always in some Zen state of mind that prevents scolding, snapping, or otherwise reacting in a way that the child might find uncomfortable.  Rather, being a parent who is “good enough” is being one that has flaws and makes mistakes, has emotions and goals of one’s own, and also one that is kind and warm and patient enough at least some part of the time to reflect on those blips and missteps and to make an effort to repair the mismatches between parent and child that can occur when we are separate human beings.  After all, your job as a parent is primarily to get your child ready for the real world; while you can interpret that to mean many things and put pressure on yourself to give him or her every opportunity to succeed, it will not help in any way to always be perfect around your child every moment of every day (even if that were possible).  Because, of course, no one else is going to be perfect to your child and won’t that be a rude awakening when your child realizes that you’ve been providing a very thick padding over life’s realities?  We all want to be helpful and kind and give our children better chances than we had, but the irony is that the harder you work and the less work your child has to do, the less he or she may appreciate and value what he or she achieves in life.   Disappointment can also be a big teacher.  While you don’t want to set your child up for disappointment, allowing them to drive the boat on a project or goal and then standing by their side while they deal with the consequences of their behavior or choices, whatever comes, can be challenging but also particularly bonding and informative for both of you.

You may have chosen to become a parent or find yourself being a parent in some other way, but you are still a human being and the best way, really, to teach other human beings how to develop in this world is to listen and help and try to be your authentic self.  It’s not easy to do one of those things, much less all of them at the same time, but that’s okay, because you don’t have to be perfect at it, just good enough.

Posted 104 weeks ago