Friday, March 2, 2018

I'm Afraid

Jennifer sits in the chair across from me and cries. Tall and thin, with straight blonde hair, at 18 years old she is younger than most of the patients I see. I suspect her distress is about the school shooting at Marjory Stoneman Douglas High School on Valentine’s Day.
“Did you lose friends in the shooting, Jennifer?”
She shakes her head.
“Are you scared it will happen in your school?”
She shakes her head.
“You know, Jennifer, I saw your Mom a number of years ago and she called and asked that I see you. Does the fact that I saw your Mom feel all right to you?
She nods, then startles. “But what I say here is just between us, right?”
“Your Mom said you just turned 18, so yes, what we say here is confidential, unless I’m afraid you’re going to hurt yourself.”
“I won’t. I’m too much of a coward to do anything like that,” she adds sobbing.
“I lot of people are really scared right now, Jennifer. That doesn’t make you a coward.”
“No, they’re not. They’re marching. They’re going to Tallahassee. To Washington. They’re confronting the NRA, the President.”
“Yes, that’s true.”
“I can’t,” she says sobbing. “I can’t do it. I’m a coward. A coward!” she says with clenched teeth, her fists covering her tightly closed eyes. “Why can’t I do it? They can.”
I immediately flash on my younger self. I so admired my grandmother, willing to fight for what she believed, while I fearfully hung back. I don’t know that I saw myself as a coward, but I did feel disappointed in myself and wished I could be different. It was a wish that was at least partially fulfilled when I was able to confront my demons from the past. But none of this will help Jennifer right now.
“That’s actually a very good question, Jennifer,  especially if you could ask it without beating yourself up. What do you think makes it so frightening for you to think about protesting like some of the other students?”
Jennifer stops crying. She looks up at me like a deer caught in the headlights. She pauses then shakes her head and says, “I can’t. I can’t say.”
“Can you tell me why you can’t?”
“I’m scared. And… and I don’t want to make it a big deal.”
“Anything that scares you so much is a big deal.”
“Can you tell me a little about your life, Jennifer? You’re an only child, right? Do you live with both your parents?”
“Yeah, it’s just me. My parents divorced. It must be a long time since you saw my Mom. They’ve been divorced since I’m nine. They had joint custody. But now that I’m 18 I’ll live with my Mom until I go to college.”
“So you prefer living with your Mom?”
“Oh yeah.”
“What’s your relationship like with each of your parents?”
“I’m real close with my Mom. My Dad, not so much.”
“Can you say why?”
“He always criticizes me. Nothing I do is ever good enough.” She hangs her head.
“Anything else?” I ask.
“He has PTSD. He was in Vietnam.”
I had forgotten that, but I remember now that Jennifer’s Mom said he could be explosive and erratic.
“Are you afraid of your Dad?” I ask gently.
“I didn’t say that!” she says, sounding panicked. “Besides, what does my Dad have to do with my being afraid to stand up for what I believe?”
“And what do you believe, Jennifer?”
“That guns kill. That we should have way more restrictions on who can get guns and what kind of guns are available.”
“What does your father believe?”
“He believes people have the right to have guns, but he doesn’t think a 19 year old should have an assault rifle.”
“What does he think about the protests?”
“He hates them. Reminds him of the Vietnam protests.”
“How would he feel if you participated?”   
“He wouldn’t allow it.”
“And what would he do if you participated anyway?”
Jennifer looks down and keeps shaking her head. “He’d scream and scream and scream. But not like normal people scream, like way, way out of control. He might also slap me or lock me in my room. He’s really scary,” she says, her words coming out in a rush.
“And you’ve been living with this all your life, Jennifer?”
“Yeah, although it got worse after the divorce. Before my mother could protect me a little. Afterwards he just got meaner. I never wanted my Mom to know. I didn’t want to upset her.”  
“Well, Jennifer, I think we know why you can’t protest as many of your friends do. But I don’t think it’s only because your father disapproves of the protests. He’s scared you your whole life, so to stand up to any authority is terrifying, just like standing up to him as a little girl was terrifying.”
“Really? You think that’s true?”

“Yes, I definitely think that’s true.”


mhmilch said...

First off I’m very impressed that you so quickly established a link between your patient’s remarks and your own life experiences. As traumas large and small and the impact of dissociative mechanisms on our patients may be how we conceptualize much of our patients’ distress today, this vignette is an important contribution to our treatment dialogue.
For me the most salient take away is the relationship between the guilt shaped by aggressive responses to unacknowledged abusive behavior, and the shame it shapes over one’s vulnerabilities to identifications with the aggressor. Your patient appears to mistakenly blame herself for what she did not cause and cannot fix, which is her father’s PTSD. I wonder to what degree she blames herself for her vengeful desires that become her defensive means to protect his goodness at the expense of her own goodness. I also wonder if in her fantasies what the patient conjures up is what might be her poorly understood expectation of his envious rage towards her for standing up for herself, something he learned to dare not to do. I’d love to hear what your thoughts on my remarks. Thanks for your post.

Linda Sherby PH.D., ABPP said...

Thanks for your comment, Mitchell.

I have a lot of thoughts about your post, the first of which is to wonder whether I did not present this patient as I intended to.

She isn't standing up for herself, that's why she feels so bad about herself. She thinks she should stand up for what she believes, but is too frightened to do so. She also doesn't see her father as good. She's afraid of him and feels she has to protect herself against his explosive rage. Of course she may still wish him to be good and wish that by her behavior she can make him good and/or win his love.

As to whether she blames herself for his PTSD, I'd say we're way too early in the treatment to know that.

Thanks again, Linda