Guilt

“I feel so awful, I can’t believe that I had to disappoint my parents. I can’t believe I couldn’t handle college, that I had to come home. My parents have always been there for me, always wanted the best for and all I do is screw up.”

This is my first session with Tiffany, a slender, attractive young woman with blue eyes and long blonde hair. Her mother, sounding concerned, had called to make the appointment, saying that Tiffany was having difficulty at Duke and needed to come home.

“I hate myself!” Tiffany continues.

“Wow! That’s pretty strong. Can you say why you hate yourself?”

“All I’ve done is give my parents problems my whole life, even before I was born. My mother had to be in bed for two months before she had me! She’s a physician – so’s my father – she can’t just take two months off. But she had to because of me.”

“That hardly sounds like your fault, Tiffany. I assume it was some medical condition your mother had.”

“She never had that problem with my brother. My brother never gives them problems. He’s graduating from Yale and going on to medical school. Of course!”

Clearly hearing her sense of competition and failure in relationship to her brother, I decide, for the moment, to focus more on her current situation. “Can you tell me what was going on for you at college?”     

“All those science courses! I can’t handle them. I’m just not smart enough. I started crying at every little thing. And I think I pretty much stopped eating. And then I couldn’t even get myself out of bed to go to class. Especially Chemistry class.  I don’t understand it. It makes me feel stupider than I already feel.”

“Are there classes that you enjoy, that you do well in?”

“Oh yes,” she says, brightening. “I love anthropology and I’m…hmm…I’m a pretty good writer.”

“So you take science courses because…?”

“What do you mean? I have to take science courses to get into medical school.”

“And do you want to go to medical school?”

“I’ve always known I’d go to medical school.”

“That’s not the same thing as wanting to go.”

“Yes, I want to go to medical school. I put my parents through a lot when I was a kid. I got rheumatic fever and ended up in the hospital for quite a while. I could tell how scared they were.”

“You must have been pretty scared too.”

“I was, particularly when I was alone. But the doctors and nurses were great. And I kind of enjoyed watching all the machines and monitors. That’s the kind of doctor I want to be, a pediatrician, to help kids like me.”

“And do your parents want you to be a doctor?”

“Definitely. It’s like a given.”

“So what if it wasn’t a given? What if you could decide to do anything you wanted to do?”

“I’d go on archeological digs and write about them or even write made-up stuff about the digs, like mysteries. But that’s not at all practical. No way to make a living.”  

“Have you ever wondered, Tiffany, why you feel so guilty in relation to your parents?”

“I told you why, I’ve always given them problems.  Besides rheumatic fever I was a sickly kid. And I broke my arm doing gymnastics. They always had to worry about me.”

“It seems that a lot of the things you feel guilty about you had absolutely no control over, like your mother needing bed rest or your having rheumatic fever or breaking your arm.”

“I was fooling around on the bar, that’s how I broke my arm.”

“You sound determined to have things be your fault. Do you think, Tiffany, if you felt things weren’t your fault, you’d end up feeling powerless and scared?”

“I don’t know. I’m not sure I know what you mean.”

Too soon for that interpretation I tell myself. I decide to pursue a different path. “Do you ever feel angry at all the pressure you’re under?”

“Angry? I don’t think so. I feel mad at myself for not being able to keep up and, like I said, worrying my parents.”

“So, now that you’re home, do you think you’re going to be able to relax and take it easy for the rest of the semester?”

“Oh no. My parents are going to get me a chemistry tutor so I can go back to school more prepared.”

At this point I find myself feeling angry at Tiffany’s parents and wonder if I’m feeling Tiffany’s unacknowledged  anger. That could explain the tremendous guilt she feels – guilt for the anger she doesn’t even know she has. But those interpretations are also premature.  

“Our time is almost up for today. But I hope I’ll be able to get to know you more and I hope you’ll tell me more about your wishes and your dreams, even if they aren’t always practical.”

“I wish you could make me smarter.”

“I don’t know if I can do that, but perhaps I can help you to be more accepting of yourself.”

Time Pressure

Charlotte began treatment with me eight months ago when her mother was diagnosed with terminal cancer. Although well into her forties, married, with children of her own, Charlotte is very dependent on her mother, talking with her several times a day and consulting her for even minor decisions. She is consumed with anxiety at the thought of her mother’s impending death. 

“I never thought she’d die!” she sobs. “I know that’s ridiculous but she seemed invincible. I thought she would live forever. I don’t know what I’ll do without her. It’s hard to imagine how I can go on.”

Charlotte is an only child who grew up in a middle class family. Her father was an accountant, a reserved, passive man who saw Charlotte as his wife’s responsibility. He wasn’t hostile or ungiving, simply absent, seemingly involved with neither Charlotte nor his wife. 

Not surprisingly, the primary connection in the family was between Charlotte and her mother. Her mother was overly protective, constantly concerned about her getting hurt and insistent that she know where Charlotte was at all times. Charlotte never rebelled. She was her mother’s constant companion. Leaving for college precipitated the onset of severe anxiety, an anxiety that still plagues her.

I am struck with the similarities between myself and Charlotte, as well as the differences. Our mothers were alike, both overly protective and fearful of letting their daughters stray too far from home. As a young child I remember wanting to stay with my mother forever. But I had a very different father, an angry, explosive, tyrannical man. I wanted to get away from him. So I had to leave home, thereby beginning the process of separating from my mother.

I knew that Charlotte also needed to separate, but her process would be more difficult since her mother’s death loomed. Time was running out.

“Charlotte, why is it that you’re so afraid of falling apart when your mother dies?”

“I can’t imagine going on without her! I can’t imagine how I’ll function. I’m not even talking about being anxious all the time, and crying all the time because I’m sure that will be true, I just don’t know how I’ll get from one day to the next.”

Feeling the pressure of time, I push way too fast. “How do feel about your mother making you so dependent on her?” 

“What are you talking about? She didn’t make me dependent, that’s just who I am.”

“It is who you are. But I wonder how you got that way. Everyone in your family, including you, contributed to your feeling what I call ‘copeless,’ feeling like you can’t do anything on your own, despite the fact that you’re clearly a competent, capable adult.”

Charlotte is thoughtful. “Well, my mother always helped me with my homework, she wanted to check out all my friends, she never wanted me to go on school trips. I don’t know about my father. He was just absent. As for me, I guess I liked my mother’s attention. It made me feel loved.”

“So maybe one thing you’re saying is that your mother helped make up for the love you didn’t feel from your father.”

“I know he loved me. He just couldn’t show it. And that’s still true. You’d think this would be a time we’d get closer, but he’s just as unavailable as always, to both me and my mother.”

“So you felt you also had to love your mother more to make up for what she didn’t get from your father.”

“I never thought of it that way, but yeah, I guess that’s true.”    

Several months later, I say, “You know, Charlotte, it is all right to be angry with both your parents…”

“No, no,” she interrupts, “I can’t be angry with my mother now.”

“I understand, Charlotte, but it doesn’t mean you’re only angry with her. Of course you love her and you’ll miss her terribly. But your father was absent and your mother was clingy and what you needed as a little girl sometimes got lost along the way.”

Charlotte sobs. 

I’m rushing the treatment. I want Charlotte to be prepared, ready for her mother’s death. But then I realize I’m doing to Charlotte just what her mother did - as well as what my mother did to me. I’m treating Charlotte as a child who can’t take care of herself. I need to listen to Charlotte, to follow her lead, not assume I know what’s best for her. 

Therapy takes a long time and this treatment is no exception. Charlotte will be however she is when her mother dies and we will deal with that then.

The Push for Success

I’ve only seen Sergio for a few sessions. Originally from Columbia, he and his wife risked all they had to come to the United States, seeking a better life for themselves and especially for their unborn children. They have four children now and it’s because of them he came to see me. 

“My wife says I push them too much. And that it got worse after Mother’s Day. You know, school’s about to get out. I tell them, I don’t want any presents, save your money. What I want is all As on your report cards. I work hard. I carry bedpans, wash people’s butts, put up with not nice people. I smile. I don’t complain. It’s a steady job. I’m lucky to have it. I’ve taken my kids to that nursing home. I show them what their father does all day. Is this what you want, I ask them? And my wife, she’s cleaning people’s houses. All we do is work.”   

“Do you think you might be pressuring them a bit too much?” I ask gingerly.

“No!” he replies emphatically, “My wife and I struggle every day. Every day we work to give them a better life. So why shouldn’t they get all As? That’s their work.” 

I like Sergio. I admire his grit, his determination. Yet conflicting and complex emotions course through me. The immigrant experience, I think warmly to myself, flashing on my beloved grandparents who only wanted “better” for their children and for me. I think of being five and sitting at their kitchen table and my grandmother telling me I was going to be the next Madame Curie. That’s the warm side, the good feelings. But then there was my father. He was contemptuous of his immigrant parents, wanting only to distance himself from them, avidly pushing education and success for both himself and me, his only child. The pressure often felt unbearable. 

“And did all you children bring you straight As?” I ask.

“No!” he says angrily.

“And you were obviously angry. How did you show your anger?”

“I wouldn’t talk with them all Father’s Day.”

Ouch! I think to myself, feeling the press to protect his children, as I wish I too had been protected.

“Sergio, is it possible that not all of your children are capable of getting straight As in every class, every time?”

“Why shouldn’t they be?”

“Well, different children have different strengths. Some are good in math and not good in English or the other way around. And sometimes if you’re too strict with children, they rebel, they try to get back at you by not doing well, even if they’re not aware of it.”

“No!” he exclaims, shaking his head from side to side. “That will not happen!”

This isn’t working. In my eagerness to protect the children, I’ve lost sight of my patient. 

“Sergio, how do you feel when say – what’s the name of your eldest?”

“Eduardo.”

“When Eduardo doesn’t get straight As?”

“Angry. He’s not working hard enough! Too much time on the computer.”

“I understand, but what does it mean for you that he’s not working hard enough. In addition to anger, what do you feel?”

Sergio sits thoughtfully. “I don’t know how to say it. It makes me feel bad. It makes me feel, I don’t know. I can’t find the words.”

“Do you think it makes you feel sad for you, for your life? You’ve made so many sacrifices. You continue to make so many sacrifices – a job you barely tolerate, long hours, no time with your wife – that it’s really, really important that your children make it all worthwhile.”

“Yes, that’s it,” he says smiling.

“I know this may be hard for you to believe, Sergio, but you can’t expect your children to make your life worthwhile. You can make your own life worthwhile. Wait! Wait!” I say, seeing that he’s about to interrupt me. “Of course you want your children to do well. But hopefully you want that for them, not for you. Hopefully you want them to do what will bring them good feelings about themselves and their lives, not necessarily what you want for them. What if Eduardo was really good working with his hands? What if he wanted to be a mechanic or a carpenter?”

“I don’t know,” he says hesitantly.

“I know,” I say. “That was a long speech.” Directed, I think to myself, to both you and to my father. “You can think about it and we’ll talk more next week.”